Provider Information for 1669533444
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Dr. CARISSA Y. FERGUSON-THOMAS MSW, MS, Psy.D.
Sex: Female
NPI: 1669533444
Last Updated: 2017-02-03
Certification Date:
Certification Date:
Details
| Name | Value | ||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| NPI | 1669533444 | ||||||||||||
| Enumeration Date | 2006-12-13 | ||||||||||||
| NPI Type | NPI-1 Individual | ||||||||||||
| Sole Proprietor | NO | ||||||||||||
| Status | Active | ||||||||||||
| Mailing Address | 110 MARTER AVE SUITE 201 MOORESTOWN, NJ 08057-3124 United States Phone: 856-778-4330 | Fax:856-778-4408 | ||||||||||||
| Primary Practice Address | 110 MARTER AVE SUITE 201 MOORESTOWN, NJ 08057-3124 United States Phone: 856-778-4330 | Fax:856-778-4408 | ||||||||||||
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