Provider Demographics
NPI:1184888604
Name:CHRISTINE FERRERA, PH.D, PSYCHOLOGICAL CORPORATION
Entity type:Organization
Organization Name:CHRISTINE FERRERA, PH.D, PSYCHOLOGICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:
Authorized Official - Last Name:FERRERA
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:707-571-7644
Mailing Address - Street 1:112 7TH ST
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95401-6203
Mailing Address - Country:US
Mailing Address - Phone:707-571-7644
Mailing Address - Fax:707-525-1589
Practice Address - Street 1:112 7TH ST
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95401-6203
Practice Address - Country:US
Practice Address - Phone:707-571-7644
Practice Address - Fax:707-525-1589
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-14
Last Update Date:2008-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY7196103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty