Kelly Ferreira

Primary specialty

Substance Abuse Rehabilitation FacilityTaxonomy code 324500000X

License

C2080275 Issued in CA

Practice address

715 Port St Apt 2
Crockett, CA 94525-1120

Phone

(510) 860-6324

NPI assigned

Sep 1, 2015

Last updated

Sep 1, 2015By the provider in NPPES

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1441065600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1441065600000",
    "number": "1629445085",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "715 PORT ST APT 2",
            "city": "CROCKETT",
            "state": "CA",
            "postal_code": "945251120",
            "telephone_number": "510-860-6324"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "715 PORT ST APT 2",
            "city": "CROCKETT",
            "state": "CA",
            "postal_code": "945251120",
            "telephone_number": "510-860-6324"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FERREIRA",
        "first_name": "KELLY",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2015-09-01",
        "last_updated": "2015-09-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "324500000X",
            "taxonomy_group": "",
            "desc": "Substance Abuse Rehabilitation Facility",
            "state": "CA",
            "license": "C2080275",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "C2080275",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Carrie McCluer & Associates
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• Abbie Lynn Cohen, MFT
• Jameisa Marie Day-Jigalin, MFT
• Jamilah El Elite, MASSAGE THERAPIST
• Melodie Isabel Griffanti, MS
• Mia Guevarra
• Daniela Jaramillo, RD
• Lorenzo Limcaco, MA, PPSC
• Carrie McCluer, MFT

• Substance Abuse Rehabilitation Facility in Crockett, CA
• Providers in Crockett, CA by specialty
• Substance Abuse Rehabilitation Facility in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 1, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.