Provider Demographics
NPI:1801669072
Name:NORTHERN CALIFORNIA CHILD PSYCHOLOGY SERVICES INC.
Entity type:Organization
Organization Name:NORTHERN CALIFORNIA CHILD PSYCHOLOGY SERVICES INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST/FOUNDER
Authorized Official - Prefix:DR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:FERRERO
Authorized Official - Suffix:JR
Authorized Official - Credentials:PSYD
Authorized Official - Phone:707-246-7416
Mailing Address - Street 1:4865 OLD REDWOOD HIGHWAY
Mailing Address - Street 2:#104
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95403
Mailing Address - Country:US
Mailing Address - Phone:707-890-6541
Mailing Address - Fax:888-528-7464
Practice Address - Street 1:4865 OLD REDWOOD HIGHWAY
Practice Address - Street 2:#104
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95403
Practice Address - Country:US
Practice Address - Phone:707-890-6541
Practice Address - Fax:888-528-7464
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-31
Last Update Date:2023-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TH0100XBehavioral Health & Social Service ProvidersPsychologistHealth ServiceGroup - Single Specialty