Basic Information
Provider Information
NPI: 1558424622
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: FERRERI
FirstName: LAURIE
MiddleName: ANN
NamePrefix: MS.
NameSuffix:  
Credential: L.P.C.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 3559 APPLETON ST NW
Address2:  
City: WASHINGTON
State: DC
PostalCode: 200082910
CountryCode: US
TelephoneNumber: 7038384455
FaxNumber: 7038385070
Practice Location
Address1: 720 N SAINT ASAPH ST
Address2:  
City: ALEXANDRIA
State: VA
PostalCode: 223141912
CountryCode: US
TelephoneNumber: 7038384455
FaxNumber: 7038385070
Other Information
ProviderEnumerationDate: 12/19/2006
LastUpdateDate: 07/08/2007
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
101YP2500X0701002258VAY Behavioral Health & Social Service ProvidersCounselorProfessional
101YP2500XPRC60DCN Behavioral Health & Social Service ProvidersCounselorProfessional

ID Information
IDTypeStateIssuerDescription
29932001VAAMERIGROUP VIRGINIA, INC.OTHER
54600110300201VATRICAREOTHER
007001VACARE FIRST BCBSOTHER
20118101VAANTHEMOTHER


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