Provider Demographics
NPI:1205170396
Name:JASON T CERRO, LPC LLC
Entity type:Organization
Organization Name:JASON T CERRO, LPC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LPC
Authorized Official - Prefix:
Authorized Official - First Name:JASON
Authorized Official - Middle Name:T
Authorized Official - Last Name:CERRO
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:401-524-5938
Mailing Address - Street 1:3175 GOLD STAR HWY
Mailing Address - Street 2:UNIT 104, G3
Mailing Address - City:MYSTIC
Mailing Address - State:CT
Mailing Address - Zip Code:06355-1200
Mailing Address - Country:US
Mailing Address - Phone:401-524-5938
Mailing Address - Fax:
Practice Address - Street 1:14 FIELDSTONE WAY
Practice Address - Street 2:
Practice Address - City:WESTERLY
Practice Address - State:RI
Practice Address - Zip Code:02891-2697
Practice Address - Country:US
Practice Address - Phone:401-524-5938
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-15
Last Update Date:2012-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI002261101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty