Provider Demographics
NPI:1891448924
Name:CERECEDES, ARIANA NICOLE
Entity Type:Individual
Prefix:
First Name:ARIANA
Middle Name:NICOLE
Last Name:CERECEDES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1005 W LARAWAY RD
Mailing Address - Street 2:
Mailing Address - City:NEW LENOX
Mailing Address - State:IL
Mailing Address - Zip Code:60451-2461
Mailing Address - Country:US
Mailing Address - Phone:815-570-9303
Mailing Address - Fax:866-950-9427
Practice Address - Street 1:1005 W LARAWAY RD
Practice Address - Street 2:
Practice Address - City:NEW LENOX
Practice Address - State:IL
Practice Address - Zip Code:60451-2461
Practice Address - Country:US
Practice Address - Phone:815-570-9303
Practice Address - Fax:866-950-9427
Is Sole Proprietor?:No
Enumeration Date:2022-01-29
Last Update Date:2022-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL150.105717104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker