Provider Demographics
NPI:1710089396
Name:CEPPETELLI, RONALD P (LICSW)
Entity Type:Individual
Prefix:
First Name:RONALD
Middle Name:P
Last Name:CEPPETELLI
Suffix:
Gender:M
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2975 ROUTE 44
Mailing Address - Street 2:
Mailing Address - City:BROWNSVILLE
Mailing Address - State:VT
Mailing Address - Zip Code:05037-9760
Mailing Address - Country:US
Mailing Address - Phone:802-674-5576
Mailing Address - Fax:802-888-9474
Practice Address - Street 1:289 COUNTY RD
Practice Address - Street 2:
Practice Address - City:WINDSOR
Practice Address - State:VT
Practice Address - Zip Code:05089-9000
Practice Address - Country:US
Practice Address - Phone:802-674-7093
Practice Address - Fax:802-674-7119
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-02
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT089-00007711041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VTOVN2170Medicaid
VTOVN2170Medicaid