Provider Demographics
NPI:1073091104
Name:CAMELO-CERRO, URSULA (LCPC, LPC)
Entity Type:Individual
Prefix:
First Name:URSULA
Middle Name:
Last Name:CAMELO-CERRO
Suffix:
Gender:F
Credentials:LCPC, LPC
Other - Prefix:
Other - First Name:URSULA
Other - Middle Name:
Other - Last Name:CERRO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCPC, LPC
Mailing Address - Street 1:1400 MERCANTILE LN STE 244
Mailing Address - Street 2:
Mailing Address - City:LARGO
Mailing Address - State:MD
Mailing Address - Zip Code:20774-5353
Mailing Address - Country:US
Mailing Address - Phone:301-346-7780
Mailing Address - Fax:
Practice Address - Street 1:6710 OXON HILL RD STE 210
Practice Address - Street 2:
Practice Address - City:OXON HILL
Practice Address - State:MD
Practice Address - Zip Code:20745-1124
Practice Address - Country:US
Practice Address - Phone:703-220-1807
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-31
Last Update Date:2024-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCPRC15517101YM0800X
MDLC10034261QM0801X
MD101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD1326189036Medicaid