Provider Demographics
NPI:1548538432
Name:FERGUSON, DAVID L (PHD)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:L
Last Name:FERGUSON
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 SW 3RD ST
Mailing Address - Street 2:SUITE 2270
Mailing Address - City:POMPANO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33060-6932
Mailing Address - Country:US
Mailing Address - Phone:954-960-8900
Mailing Address - Fax:
Practice Address - Street 1:600 SW 3RD ST
Practice Address - Street 2:SUITE 2270
Practice Address - City:POMPANO BEACH
Practice Address - State:FL
Practice Address - Zip Code:33060-6932
Practice Address - Country:US
Practice Address - Phone:954-960-8900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-06
Last Update Date:2011-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW23401041C0700X
FLMT1072106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical