Provider Demographics
NPI:1457483539
Name:CECERE, SUSAN C (PHD)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:C
Last Name:CECERE
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 1:45 SHERIDAN ROAD
Mailing Address - Street 2:
Mailing Address - City:ARNOLD
Mailing Address - State:MD
Mailing Address - Zip Code:21012-2319
Mailing Address - Country:US
Mailing Address - Phone:410-757-6440
Mailing Address - Fax:410-222-1652
Practice Address - Street 1:45 SHERIDAN ROAD
Practice Address - Street 2:
Practice Address - City:ARNOLD
Practice Address - State:MD
Practice Address - Zip Code:21012-2319
Practice Address - Country:US
Practice Address - Phone:410-757-6440
Practice Address - Fax:410-222-1652
Is Sole Proprietor?:No
Enumeration Date:2007-03-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD1673103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDG366OtherBCBS
MDT3580001OtherBCBS
MD228681OtherMAMSI