Provider Demographics
NPI:1700864691
Name:CERNI, SUSAN IVA (MA, LMHC)
Entity Type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:IVA
Last Name:CERNI
Suffix:
Gender:F
Credentials:MA, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:106 CHERRYWOOD GARDENS DR
Mailing Address - Street 2:
Mailing Address - City:MAITLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32751-3412
Mailing Address - Country:US
Mailing Address - Phone:407-790-9149
Mailing Address - Fax:866-644-6220
Practice Address - Street 1:6216 NW 43RD ST
Practice Address - Street 2:STE 3C
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32653-8860
Practice Address - Country:US
Practice Address - Phone:352-379-1988
Practice Address - Fax:866-644-6220
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-03
Last Update Date:2010-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLFL MH3763101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health