Provider Demographics
NPI:1073635322
Name:FEROLETO, MARIA ELENA (PHD)
Entity type:Individual
Prefix:DR
First Name:MARIA
Middle Name:ELENA
Last Name:FEROLETO
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1836 SUL ROSS ST APT 3
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77098-2659
Mailing Address - Country:US
Mailing Address - Phone:713-557-9709
Mailing Address - Fax:713-529-2648
Practice Address - Street 1:1501 CROCKER ST STE 1
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77019-4322
Practice Address - Country:US
Practice Address - Phone:713-630-0701
Practice Address - Fax:713-529-2648
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-06
Last Update Date:2016-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX30728103TC0700X
TX30834103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX330142OtherUBH PROVIDER #
TXFEROL-0001OtherCOMPCARE PROVIDER #
TX10009201OtherAMERIGROUP PROVIDER #
TX040537504Medicaid
TX330142OtherUBH PROVIDER #