Provider Demographics
NPI:1871891671
Name:FERGUSON, KATHLEEN (MS BCBA)
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:
Last Name:FERGUSON
Suffix:
Gender:F
Credentials:MS BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:360 ELECTRIC AVE
Mailing Address - Street 2:
Mailing Address - City:FITCHBURG
Mailing Address - State:MA
Mailing Address - Zip Code:01420-5354
Mailing Address - Country:US
Mailing Address - Phone:978-343-8392
Mailing Address - Fax:978-343-0360
Practice Address - Street 1:360 ELECTRIC AVE
Practice Address - Street 2:
Practice Address - City:FITCHBURG
Practice Address - State:MA
Practice Address - Zip Code:01420-5354
Practice Address - Country:US
Practice Address - Phone:978-343-8392
Practice Address - Fax:978-343-0360
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-03
Last Update Date:2011-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst