MEDICARE: NORTHERN CALIFORNIA CHILD PSYCHOLOGY SERVICES INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TH0100X	Health Service Psychologist

General Provider Information

NPI Number	:	1801669072
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NORTHERN CALIFORNIA CHILD PSYCHOLOGY SERVICES INC.

Provider Business Mailing Address
First Line	:	4865 OLD REDWOOD HIGHWAY
Second Line	:	#104
City	:	SANTA ROSA
State	:	CA
Zip	:	95403
Country	:	US
Telephone Number	:	707-890-6541
Fax Number	:	888-528-7464

Provider Business Practice Location Address
First Line	:	4865 OLD REDWOOD HIGHWAY
Second Line	:	#104
City	:	SANTA ROSA
State	:	CA
Zip	:	95403
Country	:	US
Telephone Number	:	707-890-6541
Fax Number	:	888-528-7464

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

Provider Enumeration Date	:	10/31/2023
Last Update Date	:	10/31/2023

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