Provider Demographics
NPI:1801931415
Name:FERRERA, SALVATOR JOHN (PHD)
Entity type:Individual
Prefix:DR
First Name:SALVATOR
Middle Name:JOHN
Last Name:FERRERA
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3023 N CLARK ST #914
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60657-5200
Mailing Address - Country:US
Mailing Address - Phone:312-316-9990
Mailing Address - Fax:773-281-4844
Practice Address - Street 1:3023 N CLARK ST #914
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60657-5200
Practice Address - Country:US
Practice Address - Phone:312-316-9990
Practice Address - Fax:773-281-4844
Is Sole Proprietor?:No
Enumeration Date:2007-02-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
R21362Medicare UPIN
939371Medicare ID - Type Unspecified