Individual
TIMOTHY FERGUSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
132 PERRY ST, TRENTON, NJ 08618-3968
(609) 394-8988
Mailing address
132 PERRY ST, TRENTON, NJ 08618-3968
(609) 394-8988
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0102903
NJ MEDICAID PROVIDER
NJ
01
—
183739
YBA4
NJ
01
—
2000078
DHS LICENSE AMBULATORY
NJ
01
—
2000345
DHS LICENSE AMBULATORY CARE
NJ
01
—
2000345-MV1-10
DHS DMHAS MOBILE UNIT
NJ
01
—
215114000
MAGELLAN MIS
NJ
01
—
7603606
WFNJ-SAI GROUP
NJ
01
—
NJ-10046-M
SUBSTANCE ABUSE AND MENTAL HEALTH
NJ
Enumeration date
01/23/2014
Last updated
01/23/2014
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