Provider Demographics
NPI:1861740490
Name:FERRACO, TAMMY (MS)
Entity type:Individual
Prefix:
First Name:TAMMY
Middle Name:
Last Name:FERRACO
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 794
Mailing Address - Street 2:
Mailing Address - City:ASHBURN
Mailing Address - State:VA
Mailing Address - Zip Code:20146-0794
Mailing Address - Country:US
Mailing Address - Phone:703-574-0350
Mailing Address - Fax:267-393-8588
Practice Address - Street 1:211 S KING ST STE C
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:VA
Practice Address - Zip Code:20175-2945
Practice Address - Country:US
Practice Address - Phone:703-574-0350
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-29
Last Update Date:2021-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0133000094103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst