Individual
KERRY BROCK FERGUSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PH.D.
Contact information
Practice address
442 N DILLARD ST STE 1, WINTER GARDEN, FL 34787-2818
(352) 536-9737
(407) 614-1900
Mailing address
PO BOX 809, MINNEOLA, FL 34755-0809
(352) 536-9737
(321) 939-3652
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
PY6092
FL
103TC0700X
Clinical Psychologist
Primary
PY6092
FL
103TE1100X
Exercise & Sports Psychologist
PY6092
FL
103TH0100X
Health Service Psychologist
PY6092
FL
Other
Enumeration date
08/08/2006
Last updated
09/14/2018
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