Provider Demographics
NPI:1730692187
Name:FERRIS, ANDREA L (MS, BCBA)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:L
Last Name:FERRIS
Suffix:
Gender:F
Credentials:MS, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 COLUMBIA ST
Mailing Address - Street 2:
Mailing Address - City:ADAMS
Mailing Address - State:MA
Mailing Address - Zip Code:01220-1361
Mailing Address - Country:US
Mailing Address - Phone:413-684-8619
Mailing Address - Fax:
Practice Address - Street 1:110 COLUMBIA ST
Practice Address - Street 2:
Practice Address - City:ADAMS
Practice Address - State:MA
Practice Address - Zip Code:01220-1361
Practice Address - Country:US
Practice Address - Phone:413-684-8619
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-08
Last Update Date:2020-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103K00000X
MA2074103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst