Provider Demographics
NPI:1336248442
Name:CERBO, VIRGINIA M (LICSW)
Entity Type:Individual
Prefix:MRS
First Name:VIRGINIA
Middle Name:M
Last Name:CERBO
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 272
Mailing Address - Street 2:
Mailing Address - City:TIVERTON
Mailing Address - State:RI
Mailing Address - Zip Code:02878-0272
Mailing Address - Country:US
Mailing Address - Phone:401-624-9981
Mailing Address - Fax:401-624-7281
Practice Address - Street 1:1061 FISH RD
Practice Address - Street 2:
Practice Address - City:TIVERTON
Practice Address - State:RI
Practice Address - Zip Code:02878-0272
Practice Address - Country:US
Practice Address - Phone:401-624-9981
Practice Address - Fax:401-624-7281
Is Sole Proprietor?:No
Enumeration Date:2006-09-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RILSW00275104100000X
MA1020771041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered104100000XBehavioral Health & Social Service ProvidersSocial Worker
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI75035OtherBLT
7503001OtherMASS BLT
RI406364OtherBLUE CHIP
774623OtherTUFTS