Provider Demographics
NPI:1154194165
Name:FERRAN, MAILEN
Entity type:Individual
Prefix:
First Name:MAILEN
Middle Name:
Last Name:FERRAN
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4461 FOREST LN
Mailing Address - Street 2:
Mailing Address - City:PALM SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33406-7505
Mailing Address - Country:US
Mailing Address - Phone:561-679-1278
Mailing Address - Fax:
Practice Address - Street 1:1601 BELVEDERE RD E-300
Practice Address - Street 2:SUITE 31
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33406-1541
Practice Address - Country:US
Practice Address - Phone:561-421-0047
Practice Address - Fax:561-421-0023
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-01
Last Update Date:2025-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-23-302688106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty