Correctional Rehabilitation Services | |
4833 Spicewood Springs Rd Ste 101 Austin TX 78759-8436 | |
(512) 708-0502 | |
(512) 708-0557 |
Full Name | Correctional Rehabilitation Services |
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Speciality | Psychologist |
Location | 4833 Spicewood Springs Rd Ste 101, Austin, Texas |
Authorized Official Name and Position | Matthew Luke Ferrara (PSYCHOLOGIST) |
Authorized Official Contact | 5127080502 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
---|---|
Correctional Rehabilitation Services 1304 Nueces Street Austin TX 78701 Ph: (512) 708-0502 | Correctional Rehabilitation Services 4833 Spicewood Springs Rd Ste 101 Austin TX 78759-8436 Ph: (512) 708-0502 |
NPI Number | 1407000508 |
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Provider Enumeration Date | 11/17/2008 |
Last Update Date | 03/30/2022 |
Certification Date | 03/30/2022 |
Medicare PECOS PAC ID | 2466519921 |
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Medicare Enrollment ID | O20090327000126 |
Identifier | Type | State | Issuer |
---|---|---|---|
1407000508 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
103T00000X | Psychologist | 22796 (Texas) | Primary |
Provider Name | Matthew Luke Ferrara |
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Provider Type | Practitioner - Psychologist Billing Independently |
Provider Identifiers | NPI Number: 1225279623 PECOS PAC ID: 0941220693 Enrollment ID: I20051128000291 |
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