Provider Demographics
NPI:1487676565
Name:FERRERA, CHRISTINE (PHD)
Entity type:Individual
Prefix:DR
First Name:CHRISTINE
Middle Name:
Last Name:FERRERA
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 1:112 7TH ST
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95401-6203
Mailing Address - Country:US
Mailing Address - Phone:707-571-7644
Mailing Address - Fax:707-525-1589
Practice Address - Street 1:112 7TH ST
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95401-6203
Practice Address - Country:US
Practice Address - Phone:707-571-7644
Practice Address - Fax:707-525-1589
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-24
Last Update Date:2008-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY7196103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA27-0075200OtherEIN