Provider Demographics
NPI:1013624360
Name:CERAK, BROOKE ALYSSA (MS)
Entity Type:Individual
Prefix:
First Name:BROOKE
Middle Name:ALYSSA
Last Name:CERAK
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1520 ATRIA CIR APT 1409
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27604-5325
Mailing Address - Country:US
Mailing Address - Phone:338-686-1120
Mailing Address - Fax:
Practice Address - Street 1:1520 ATRIA CIR APT 1409
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27604-5325
Practice Address - Country:US
Practice Address - Phone:336-686-1120
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-04
Last Update Date:2022-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC12467A106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist