Provider Demographics
NPI:1497076848
Name:CERMINARA, GINA MARIE (LPC)
Entity Type:Individual
Prefix:MS
First Name:GINA
Middle Name:MARIE
Last Name:CERMINARA
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5801 WASHINGTON AVE
Mailing Address - Street 2:SUITE 110
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:WI
Mailing Address - Zip Code:53406-4057
Mailing Address - Country:US
Mailing Address - Phone:262-884-9734
Mailing Address - Fax:262-884-9735
Practice Address - Street 1:5801 WASHINGTON AVENUE
Practice Address - Street 2:SUITE 110
Practice Address - City:RACINE
Practice Address - State:WI
Practice Address - Zip Code:53406
Practice Address - Country:US
Practice Address - Phone:262-884-9734
Practice Address - Fax:262-884-9735
Is Sole Proprietor?:No
Enumeration Date:2010-06-21
Last Update Date:2011-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4249101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional