Provider Demographics
NPI:1609472109
Name:CERAVOLO, ALEXANDRIA ROSE (LCSW)
Entity Type:Individual
Prefix:
First Name:ALEXANDRIA
Middle Name:ROSE
Last Name:CERAVOLO
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:309 SUMMIT AVE
Mailing Address - Street 2:
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07306-2416
Mailing Address - Country:US
Mailing Address - Phone:646-258-2075
Mailing Address - Fax:
Practice Address - Street 1:60 EAST RD
Practice Address - Street 2:
Practice Address - City:BLAUVELT
Practice Address - State:NY
Practice Address - Zip Code:10913-2017
Practice Address - Country:US
Practice Address - Phone:646-258-2075
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-09
Last Update Date:2023-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1083901041C0700X
NY0954111041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical