Individual
GLENN EUGENE FERGUSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PHD
Contact information
Practice address
206 S CORONADO AVE, ESPANOLA, NM 87532-2792
(860) 788-6404
Mailing address
PO BOX 1595, MIDDLETOWN, CT 06457-8095
(860) 788-6404
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
44SI00428700
NJ
103TC0700X
Clinical Psychologist
Primary
PSY-2022-0061
NM
103TC0700X
Clinical Psychologist
PSY.0004552
CO
Other
Enumeration date
05/24/2011
Last updated
07/08/2024
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