Provider Demographics
NPI:1588741342
Name:FERRIS, CAREN (MD)
Entity type:Individual
Prefix:
First Name:CAREN
Middle Name:
Last Name:FERRIS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2864 SE TREASURE ISLAND RD
Mailing Address - Street 2:
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34952-5730
Mailing Address - Country:US
Mailing Address - Phone:413-374-3174
Mailing Address - Fax:
Practice Address - Street 1:2864 SE TREASURE ISLAND RD
Practice Address - Street 2:
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34952-5730
Practice Address - Country:US
Practice Address - Phone:413-374-3174
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2022-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME1331562084P0800X
MA591842084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA12330OtherHEALTH NEW ENGLAND
MAJ30171OtherBLUE CROSS/BLUE SHIELD
MAJ30171OtherBLUE CROSS/BLUE SHIELD