Provider Demographics
NPI:1639614043
Name:CERRILLO, NATASHA (LMFT BCBA)
Entity Type:Individual
Prefix:
First Name:NATASHA
Middle Name:
Last Name:CERRILLO
Suffix:
Gender:F
Credentials:LMFT BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1009 VALLEY WIND WAY
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95351-4957
Mailing Address - Country:US
Mailing Address - Phone:209-206-5164
Mailing Address - Fax:
Practice Address - Street 1:200 N BROADWAY STE F
Practice Address - Street 2:
Practice Address - City:TURLOCK
Practice Address - State:CA
Practice Address - Zip Code:95380-4755
Practice Address - Country:US
Practice Address - Phone:209-416-4866
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-21
Last Update Date:2021-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA107609101YM0800X
CA1-19-37445103K00000X
CA120130106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst