Provider Demographics
NPI:1497873095
Name:FERA, THOMAS WALTER (PHD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:WALTER
Last Name:FERA
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6740 VESPER AVE
Mailing Address - Street 2:SUITE 203
Mailing Address - City:VAN NUYS
Mailing Address - State:CA
Mailing Address - Zip Code:91405-4612
Mailing Address - Country:US
Mailing Address - Phone:818-780-9078
Mailing Address - Fax:818-780-8457
Practice Address - Street 1:6740 VESPER AVE
Practice Address - Street 2:SUITE 203
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91405-4612
Practice Address - Country:US
Practice Address - Phone:818-780-9078
Practice Address - Fax:818-780-8457
Is Sole Proprietor?:No
Enumeration Date:2007-03-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY8524103TF0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensic