Provider Demographics
NPI:1306164330
Name:FERGUSON, JOHN SCOTT (LMSW)
Entity type:Individual
Prefix:MR
First Name:JOHN
Middle Name:SCOTT
Last Name:FERGUSON
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3415 WARD DR NW
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87120-1145
Mailing Address - Country:US
Mailing Address - Phone:505-831-9260
Mailing Address - Fax:
Practice Address - Street 1:3415 WARD DR NW
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87120-1145
Practice Address - Country:US
Practice Address - Phone:505-831-9260
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-14
Last Update Date:2010-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMM-06919104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker