Provider Demographics
NPI:1568473288
Name:FERRERA, CYN THIA (PHD)
Entity Type:Individual
Prefix:DR
First Name:CYN THIA
Middle Name:
Last Name:FERRERA
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 BROOKWOOD AVE
Mailing Address - Street 2:STE 200
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95404-5258
Mailing Address - Country:US
Mailing Address - Phone:707-525-9067
Mailing Address - Fax:
Practice Address - Street 1:101 BROOKWOOD AVE
Practice Address - Street 2:STE 200
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95404-5258
Practice Address - Country:US
Practice Address - Phone:707-525-9067
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY11071103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAOPL110710Medicare ID - Type Unspecified