Provider Demographics
NPI:1215483102
Name:FERMAN, CARMON THERESE (LMSW)
Entity type:Individual
Prefix:MRS
First Name:CARMON
Middle Name:THERESE
Last Name:FERMAN
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8519 WILDLIFE TRL
Mailing Address - Street 2:
Mailing Address - City:BELDING
Mailing Address - State:MI
Mailing Address - Zip Code:48809-1060
Mailing Address - Country:US
Mailing Address - Phone:616-835-3053
Mailing Address - Fax:
Practice Address - Street 1:309 1/2 S LAFAYETTE ST STE 202
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:MI
Practice Address - Zip Code:48838-1967
Practice Address - Country:US
Practice Address - Phone:616-255-3963
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-30
Last Update Date:2018-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010984101041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI6801098410OtherSTATE OF MICHIGAN