Provider Demographics
NPI:1598260887
Name:FERGUSON, EMELINE SPEYER (LCSW)
Entity type:Individual
Prefix:MS
First Name:EMELINE
Middle Name:SPEYER
Last Name:FERGUSON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:280 GANNETT DRIVE
Mailing Address - Street 2:STE B
Mailing Address - City:SOUTH PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04106
Mailing Address - Country:US
Mailing Address - Phone:207-828-0048
Mailing Address - Fax:207-756-6228
Practice Address - Street 1:280 GANNETT DRIVE
Practice Address - Street 2:STE B
Practice Address - City:SOUTH PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04106
Practice Address - Country:US
Practice Address - Phone:207-828-0048
Practice Address - Fax:207-756-6228
Is Sole Proprietor?:No
Enumeration Date:2018-03-28
Last Update Date:2024-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC240321041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical