Provider Demographics
NPI:1932316957
Name:CERRI, MARK MARIO (PHD)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:MARIO
Last Name:CERRI
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 W CLAY ST
Mailing Address - Street 2:
Mailing Address - City:UKIAH
Mailing Address - State:CA
Mailing Address - Zip Code:95482-5452
Mailing Address - Country:US
Mailing Address - Phone:707-972-9357
Mailing Address - Fax:707-462-5881
Practice Address - Street 1:205 W CLAY ST
Practice Address - Street 2:
Practice Address - City:UKIAH
Practice Address - State:CA
Practice Address - Zip Code:95482-5452
Practice Address - Country:US
Practice Address - Phone:707-972-9357
Practice Address - Fax:707-462-5881
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-17
Last Update Date:2014-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY21095103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical