Active NPI
Carissa Y. Ferguson-Thomas, MSW, MS, PSY.D.
- Clinical Psychologist
- Moorestown, NJ
National Provider Identifier
1669533444
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 5528
- Practice address
- 110 Marter Ave
Suite 201
Moorestown, NJ 08057-3124 - Phone
- (856) 778-4330
- Fax
- (856) 778-4408
- NPI assigned
- Dec 13, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | CW014630 | PA | |
| Clinical Psychologist | 103TC0700X | 5528 | NJ | Primary |
Addresses
Primary practice location
110 Marter Ave
Suite 201
Moorestown, NJ 08057-3124
Mailing address
110 Marter Ave
Suite 201
Moorestown, NJ 08057-3124
Phone (856) 778-4330
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1215470174 | Medicaid | NJ |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5528 | NJ | MD | Clinical Psychologist |
| CW014630 | PA | MD | Clinical Social Worker |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Teladoc Health Medical Group, P.a. | Clinical | Current | Accepting new patients |
| Delaware Valley Psychological Services, LLC. | Past | Accepting new patients |
Interoperability endpoints
- carissafergusonthomas@tdh.allscriptsdirect.net
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Psychologist
- Moorestown, NJ
- NPI 1215470174
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1165968000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1486080000000",
"number": "1669533444",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "110 MARTER AVE",
"address_2": "SUITE 201",
"city": "MOORESTOWN",
"state": "NJ",
"postal_code": "080573124",
"telephone_number": "856-778-4330",
"fax_number": "856-778-4408"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "110 MARTER AVE",
"address_2": "SUITE 201",
"city": "MOORESTOWN",
"state": "NJ",
"postal_code": "080573124",
"telephone_number": "856-778-4330",
"fax_number": "856-778-4408"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FERGUSON-THOMAS",
"first_name": "CARISSA",
"middle_name": "Y.",
"name_prefix": "Dr.",
"credential": "MSW, MS, PSY.D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-12-13",
"last_updated": "2017-02-03",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "PA",
"license": "CW014630",
"primary": false
},
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "NJ",
"license": "5528",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1215470174",
"state": "NJ"
}
],
"endpoints": [],
"other_names": []
}Other providers in Moorestown, NJ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 3, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.