Provider Demographics
NPI:1861736092
Name:FERRERA, JOHN J (PHD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:J
Last Name:FERRERA
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1548 64TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11219-5730
Mailing Address - Country:US
Mailing Address - Phone:917-921-7154
Mailing Address - Fax:
Practice Address - Street 1:65 BROADWAY
Practice Address - Street 2:SUITE 812
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10006-2503
Practice Address - Country:US
Practice Address - Phone:917-300-8006
Practice Address - Fax:917-210-3184
Is Sole Proprietor?:No
Enumeration Date:2012-11-10
Last Update Date:2013-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY018945103TC2200X, 103G00000X, 103TB0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
No103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral