Provider Demographics
NPI:1902201858
Name:CERBONE, CHARLTON (MA LMHC)
Entity Type:Individual
Prefix:
First Name:CHARLTON
Middle Name:
Last Name:CERBONE
Suffix:
Gender:M
Credentials:MA LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12543 TAMIAMI TRL S
Mailing Address - Street 2:
Mailing Address - City:NORTH PORT
Mailing Address - State:FL
Mailing Address - Zip Code:34287-1446
Mailing Address - Country:US
Mailing Address - Phone:941-876-3060
Mailing Address - Fax:941-257-8395
Practice Address - Street 1:12543 TAMIAMI TRL S
Practice Address - Street 2:
Practice Address - City:NORTH PORT
Practice Address - State:FL
Practice Address - Zip Code:34287-1446
Practice Address - Country:US
Practice Address - Phone:941-876-3060
Practice Address - Fax:941-257-8395
Is Sole Proprietor?:No
Enumeration Date:2014-11-04
Last Update Date:2014-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH 12784101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health