Provider Demographics
NPI:1225279623
Name:FERRARA, MATTHEW LUKE (PHD)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:LUKE
Last Name:FERRARA
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4833 SPICEWOOD SPRINGS RD STE 101
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78759-8436
Mailing Address - Country:US
Mailing Address - Phone:512-708-0502
Mailing Address - Fax:
Practice Address - Street 1:4833 SPICEWOOD SPRINGS RD STE 101
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78759-8436
Practice Address - Country:US
Practice Address - Phone:512-708-0502
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-13
Last Update Date:2022-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX22796103T00000X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist