Provider Demographics
NPI:1861681934
Name:SCERBO, ALEXANDER J (CNS)
Entity Type:Individual
Prefix:
First Name:ALEXANDER
Middle Name:J
Last Name:SCERBO
Suffix:
Gender:M
Credentials:CNS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 MARSHALL RD
Mailing Address - Street 2:LOWELL CBOC
Mailing Address - City:LOWELL
Mailing Address - State:MA
Mailing Address - Zip Code:01852-5130
Mailing Address - Country:US
Mailing Address - Phone:978-671-9113
Mailing Address - Fax:
Practice Address - Street 1:130 MARSHALL RD
Practice Address - Street 2:LOWELL CBOC
Practice Address - City:LOWELL
Practice Address - State:MA
Practice Address - Zip Code:01852-5130
Practice Address - Country:US
Practice Address - Phone:978-671-9113
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-10-15
Last Update Date:2020-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN268132364SP0812X
MA268132363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Yes364SP0812XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Community