Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TS0200X | School Psychologist | 0606676 | VA |
NPI | 1083202634 |
---|---|
Provider Name | Stephen Ferrara |
First Address | Charlottesville, VA 22903-1304 |
Second Address | Charlottesville, VA 22903-3899 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/01/2021 |
Last Update Date | 08/01/2021 |