Provider Demographics
NPI:1154743284
Name:FEROLLA, BREANNA CAREY (MSW, LICSW)
Entity type:Individual
Prefix:MRS
First Name:BREANNA
Middle Name:CAREY
Last Name:FEROLLA
Suffix:
Gender:F
Credentials:MSW, LICSW
Other - Prefix:
Other - First Name:BREANNA
Other - Middle Name:CAREY
Other - Last Name:TILLERY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4 A ST
Mailing Address - Street 2:
Mailing Address - City:HOPKINTON
Mailing Address - State:MA
Mailing Address - Zip Code:01748-1216
Mailing Address - Country:US
Mailing Address - Phone:508-686-1338
Mailing Address - Fax:508-205-0331
Practice Address - Street 1:4 A ST
Practice Address - Street 2:
Practice Address - City:HOPKINTON
Practice Address - State:MA
Practice Address - Zip Code:01748-1216
Practice Address - Country:US
Practice Address - Phone:508-686-1338
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-08
Last Update Date:2022-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1237191041C0700X
MA000224228251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical