Healthcare Provider Details

I. General information

NPI: 1801669072
Provider Name (Legal Business Name): NORTHERN CALIFORNIA CHILD PSYCHOLOGY SERVICES INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/31/2023
Last Update Date: 10/31/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4865 OLD REDWOOD HIGHWAY #104
SANTA ROSA CA
95403
US

IV. Provider business mailing address

4865 OLD REDWOOD HIGHWAY #104
SANTA ROSA CA
95403
US

V. Phone/Fax

Practice location:
  • Phone: 707-890-6541
  • Fax: 888-528-7464
Mailing address:
  • Phone: 707-890-6541
  • Fax: 888-528-7464

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TH0100X
TaxonomyHealth Service Psychologist
License Number
License Number State

VIII. Authorized Official

Name: DR. EDWARD JOSEPH FERRERO JR.
Title or Position: PSYCHOLOGIST/FOUNDER
Credential: PSYD.
Phone: 707-246-7416