Provider Demographics
NPI:1427476068
Name:FERGUSON, ELIZABETH ANN (LCSW)
Entity type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:ANN
Last Name:FERGUSON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:ELIZABETH
Other - Middle Name:
Other - Last Name:ENGELMAN-FERGUSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:1635 S RIDGEWOOD AVE STE 225
Mailing Address - Street 2:
Mailing Address - City:SOUTH DAYTONA
Mailing Address - State:FL
Mailing Address - Zip Code:32119-8478
Mailing Address - Country:US
Mailing Address - Phone:386-788-5021
Mailing Address - Fax:386-788-5021
Practice Address - Street 1:1635 S RIDGEWOOD AVE STE 225
Practice Address - Street 2:
Practice Address - City:SOUTH DAYTONA
Practice Address - State:FL
Practice Address - Zip Code:32119-8478
Practice Address - Country:US
Practice Address - Phone:386-788-5021
Practice Address - Fax:386-788-5021
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-01
Last Update Date:2017-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW 108931041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical