Provider Demographics
NPI:1710605266
Name:CERICOLA, CHRISTINE (LICSW)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:
Last Name:CERICOLA
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29 BRADFORD TER
Mailing Address - Street 2:
Mailing Address - City:LYNN
Mailing Address - State:MA
Mailing Address - Zip Code:01905-1101
Mailing Address - Country:US
Mailing Address - Phone:508-527-2671
Mailing Address - Fax:
Practice Address - Street 1:10 HARBOR ST
Practice Address - Street 2:
Practice Address - City:DANVERS
Practice Address - State:MA
Practice Address - Zip Code:01923-3390
Practice Address - Country:US
Practice Address - Phone:978-619-6801
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-19
Last Update Date:2022-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical