Provider Demographics
NPI:1407557630
Name:CERASOLI, CHERYL ANN (LMFT)
Entity Type:Individual
Prefix:
First Name:CHERYL
Middle Name:ANN
Last Name:CERASOLI
Suffix:
Gender:F
Credentials:LMFT
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 393
Mailing Address - Street 2:
Mailing Address - City:HOPE
Mailing Address - State:ID
Mailing Address - Zip Code:83836-0393
Mailing Address - Country:US
Mailing Address - Phone:760-807-9842
Mailing Address - Fax:
Practice Address - Street 1:138 RIDGEWOOD AVE
Practice Address - Street 2:
Practice Address - City:HOPE
Practice Address - State:ID
Practice Address - Zip Code:83836-5104
Practice Address - Country:US
Practice Address - Phone:760-807-9842
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-14
Last Update Date:2023-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA42764106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist