Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 102L00000X | Psychologist | PS006249L | PA |
Y | 103T00000X | Psychologist | PS006249L | PA |
N | 103TB0200X | Cognitive & Behavioral Psychologist | PS006249L | PA |
NPI | 1093766123 |
---|---|
Provider Name | Jean K Ferguson |
First Address | Lancaster, PA 17602-7000 |
Second Address | Lancaster, PA 17601-4985 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/05/2006 |
Last Update Date | 26/06/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
02045902 | CAPITAL BLUE CROSS (01) | PA |
188829 | VALUE OPTIONS (01) | PA |