Provider Demographics
NPI:1972044022
Name:FERGUSON, LAURIE JEAN (PHD)
Entity type:Individual
Prefix:DR
First Name:LAURIE
Middle Name:JEAN
Last Name:FERGUSON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:83 CLOSTER RD
Mailing Address - Street 2:
Mailing Address - City:PALISADES
Mailing Address - State:NY
Mailing Address - Zip Code:10964-1528
Mailing Address - Country:US
Mailing Address - Phone:845-398-1174
Mailing Address - Fax:
Practice Address - Street 1:1 KINGS HWY
Practice Address - Street 2:
Practice Address - City:TAPPAN
Practice Address - State:NY
Practice Address - Zip Code:10983-2008
Practice Address - Country:US
Practice Address - Phone:845-398-1174
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-09
Last Update Date:2017-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY018763103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical