Provider Demographics
NPI:1942427554
Name:FERRER, JUAN PABLO (PSYD, EDM)
Entity Type:Individual
Prefix:DR
First Name:JUAN PABLO
Middle Name:
Last Name:FERRER
Suffix:
Gender:M
Credentials:PSYD, EDM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:804 ARBOR RD
Mailing Address - Street 2:
Mailing Address - City:MENLO PARK
Mailing Address - State:CA
Mailing Address - Zip Code:94025-5022
Mailing Address - Country:US
Mailing Address - Phone:650-564-7798
Mailing Address - Fax:
Practice Address - Street 1:804 ARBOR RD
Practice Address - Street 2:
Practice Address - City:MENLO PARK
Practice Address - State:CA
Practice Address - Zip Code:94025-5022
Practice Address - Country:US
Practice Address - Phone:650-564-7798
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-18
Last Update Date:2017-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA25776103TC0700X, 103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent