Provider Demographics
NPI:1386699338
Name:FERRERA, STEPHANIE J (LCSW)
Entity type:Individual
Prefix:MS
First Name:STEPHANIE
Middle Name:J
Last Name:FERRERA
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 SOUTH MAPLE AVENUE
Mailing Address - Street 2:
Mailing Address - City:OAK PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60302-3026
Mailing Address - Country:US
Mailing Address - Phone:708-383-7566
Mailing Address - Fax:708-383-4766
Practice Address - Street 1:200 SOUTH MAPLE AVENUE
Practice Address - Street 2:
Practice Address - City:OAK PARK
Practice Address - State:IL
Practice Address - Zip Code:60302-3026
Practice Address - Country:US
Practice Address - Phone:708-383-7566
Practice Address - Fax:708-383-4766
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
1604502OtherBLUE CROSS
IL3344330Medicare ID - Type Unspecified