1700428364 NPI number — MS. CANDICE LYNN FERRETTI MS, LAC, NCC

Table of content: MS. CANDICE LYNN FERRETTI MS, LAC, NCC (NPI 1700428364)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1700428364 NPI number — MS. CANDICE LYNN FERRETTI MS, LAC, NCC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FERRETTI
Provider First Name:
CANDICE
Provider Middle Name:
LYNN
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
MS, LAC, NCC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1700428364
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/15/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1203 MAUI DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FORKED RIVER
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08731-4705
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
732-921-1494
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
OCEAN MENTAL HEALTH SERVICES- CRISIS STABILIZATION
Provider Second Line Business Practice Location Address:
712 E. BAY AVE STE 21-E
Provider Business Practice Location Address City Name:
MANAHAWKIN
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08050
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
609-597-5327
Provider Business Practice Location Address Fax Number:
609-597-6499
Provider Enumeration Date:
10/15/2019

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X , with the licence number:  37AC00464800 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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