Provider Demographics
NPI:1871673327
Name:CECERE, SUSAN JENNIFER (LPC)
Entity Type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:JENNIFER
Last Name:CECERE
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:MS
Other - First Name:SUSAN
Other - Middle Name:JENNIFER
Other - Last Name:NEWMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC
Mailing Address - Street 1:15517 LAUREL RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:MONTCLAIR
Mailing Address - State:VA
Mailing Address - Zip Code:22025-1018
Mailing Address - Country:US
Mailing Address - Phone:703-878-4710
Mailing Address - Fax:703-792-5699
Practice Address - Street 1:7969 ASHTON AVE
Practice Address - Street 2:
Practice Address - City:MANASSAS
Practice Address - State:VA
Practice Address - Zip Code:20109-2885
Practice Address - Country:US
Practice Address - Phone:703-792-7800
Practice Address - Fax:703-792-5699
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-17
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701002654101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA210245OtherBLUE CROSS BLUE SHIELD
VA210245OtherBLUE CROSS BLUE SHIELD