Provider Demographics
NPI:1902309610
Name:FERRER, KAREN (EDS)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:
Last Name:FERRER
Suffix:
Gender:F
Credentials:EDS
Other - Prefix:
Other - First Name:KAREN
Other - Middle Name:L
Other - Last Name:GRISSMER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:EDS
Mailing Address - Street 1:4217 RED HILL RD
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22903-7922
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4217 RED HILL RD
Practice Address - Street 2:
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22903-7922
Practice Address - Country:US
Practice Address - Phone:434-977-5615
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-09
Last Update Date:2018-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0813000107103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0813000107Medicaid