Provider Demographics
NPI:1306886999
Name:FERGUSON, DAVID (LCSW)
Entity type:Individual
Prefix:MR
First Name:DAVID
Middle Name:
Last Name:FERGUSON
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 W 57TH ST
Mailing Address - Street 2:8TH FLOOR
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10019-3320
Mailing Address - Country:US
Mailing Address - Phone:212-632-4482
Mailing Address - Fax:212-632-4495
Practice Address - Street 1:120 W 57TH ST
Practice Address - Street 2:8TH FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10019-3320
Practice Address - Country:US
Practice Address - Phone:212-632-4482
Practice Address - Fax:212-632-4495
Is Sole Proprietor?:No
Enumeration Date:2006-06-08
Last Update Date:2010-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR036639-1101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYN0J961Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER