Provider Demographics
NPI:1336683499
Name:CERRUTO, AUDRA (PHD)
Entity Type:Individual
Prefix:
First Name:AUDRA
Middle Name:
Last Name:CERRUTO
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 1:1000 HEMPSTEAD AVE
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE CENTRE
Mailing Address - State:NY
Mailing Address - Zip Code:11570-1135
Mailing Address - Country:US
Mailing Address - Phone:516-323-3329
Mailing Address - Fax:516-323-3323
Practice Address - Street 1:1000 HEMPSTEAD AVE
Practice Address - Street 2:
Practice Address - City:ROCKVILLE CENTRE
Practice Address - State:NY
Practice Address - Zip Code:11570-1135
Practice Address - Country:US
Practice Address - Phone:516-323-3329
Practice Address - Fax:516-323-3323
Is Sole Proprietor?:No
Enumeration Date:2016-12-08
Last Update Date:2016-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY021919103TB0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral