Provider Demographics
NPI:1568147726
Name:DOSSMAN, CERISE AILEEN
Entity Type:Individual
Prefix:
First Name:CERISE
Middle Name:AILEEN
Last Name:DOSSMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:CERISE
Other - Middle Name:AILEEN
Other - Last Name:SNUGGS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:310 CORONADO AVE
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90814-2610
Mailing Address - Country:US
Mailing Address - Phone:562-786-4407
Mailing Address - Fax:
Practice Address - Street 1:310 CORONADO AVE
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90814-2610
Practice Address - Country:US
Practice Address - Phone:562-786-4407
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-15
Last Update Date:2023-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1099951041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical