Basic Information
Provider Information
NPI: 1124069596
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: FERRIS
FirstName: SABRINA
MiddleName:  
NamePrefix: MS.
NameSuffix:  
Credential: LICSW
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 85 FRANKLIN ST
Address2:  
City: ALLSTON
State: MA
PostalCode: 021341410
CountryCode: US
TelephoneNumber: 6172548570
FaxNumber:  
Practice Location
Address1: 330 BROOKLINE AVE
Address2: CARL J. SHAPIRO CLINICAL CENTER, 6TH FLOOR
City: BOSTON
State: MA
PostalCode: 022155400
CountryCode: US
TelephoneNumber: 6176679600
FaxNumber:  
Other Information
ProviderEnumerationDate: 06/09/2006
LastUpdateDate: 07/08/2007
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: X
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
1041C0700X111515MAY Behavioral Health & Social Service ProvidersSocial WorkerClinical

No ID Information.


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