Provider Demographics
NPI:1730550534
Name:FERRERO, EDWARD
Entity type:Individual
Prefix:
First Name:EDWARD
Middle Name:
Last Name:FERRERO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1950 ADDISON ST
Mailing Address - Street 2:SUITE 109
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94704-1176
Mailing Address - Country:US
Mailing Address - Phone:510-548-9716
Mailing Address - Fax:
Practice Address - Street 1:4865 OLD REDWOOD HWY STE 102
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95403-1415
Practice Address - Country:US
Practice Address - Phone:707-890-6541
Practice Address - Fax:888-528-7464
Is Sole Proprietor?:No
Enumeration Date:2015-10-19
Last Update Date:2024-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA32838103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist