Provider Demographics
NPI:1184738106
Name:CERULLO, MICHAEL C JR (MS, LMHC)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:C
Last Name:CERULLO
Suffix:JR
Gender:
Credentials:MS, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:60 LITTLE WOODS PATH
Mailing Address - Street 2:
Mailing Address - City:WAKEFIELD
Mailing Address - State:RI
Mailing Address - Zip Code:02879-1829
Mailing Address - Country:US
Mailing Address - Phone:401-286-0804
Mailing Address - Fax:401-295-8157
Practice Address - Street 1:60 LITTLE WOODS PATH
Practice Address - Street 2:
Practice Address - City:WAKEFIELD
Practice Address - State:RI
Practice Address - Zip Code:02879-1829
Practice Address - Country:US
Practice Address - Phone:401-286-0804
Practice Address - Fax:401-295-8157
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-18
Last Update Date:2025-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMHC00171101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI00409983-001OtherBLUE CROSS BLUE CHIP
RI1031070OtherNEIGHBORHOOD HEALTH RI
RI820288000OtherMAGELLAN
RIMC45883Medicaid
RI0000022750-001OtherBLUE CROSS/BLUE SHIELD RI
RI62-77092OtherUNITED BEHAVIORAL HEALTH