Provider Demographics
NPI:1023198140
Name:CERIO, NANCY GREENE (PHD)
Entity Type:Individual
Prefix:DR
First Name:NANCY
Middle Name:GREENE
Last Name:CERIO
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:PO BOX 782
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:NY
Mailing Address - Zip Code:13617-0782
Mailing Address - Country:US
Mailing Address - Phone:315-854-6074
Mailing Address - Fax:315-714-3146
Practice Address - Street 1:91 MAIN ST
Practice Address - Street 2:SUITE 200
Practice Address - City:CANTON
Practice Address - State:NY
Practice Address - Zip Code:13617-1248
Practice Address - Country:US
Practice Address - Phone:315-854-6074
Practice Address - Fax:315-714-3146
Is Sole Proprietor?:No
Enumeration Date:2006-10-16
Last Update Date:2014-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD2110103TC0700X
NY019159103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDK029081NMedicare ID - Type Unspecified