Provider Demographics
NPI:1770757965
Name:CECE, JOHN L (LSW LMHC)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:L
Last Name:CECE
Suffix:
Gender:M
Credentials:LSW LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:442 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CROWN POINT
Mailing Address - State:IN
Mailing Address - Zip Code:46307-4402
Mailing Address - Country:US
Mailing Address - Phone:219-662-3977
Mailing Address - Fax:219-662-1275
Practice Address - Street 1:442 S MAIN ST
Practice Address - Street 2:
Practice Address - City:CROWN POINT
Practice Address - State:IN
Practice Address - Zip Code:46307-4402
Practice Address - Country:US
Practice Address - Phone:219-662-3977
Practice Address - Fax:219-662-1275
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-17
Last Update Date:2008-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN39000009A101YM0800X
IN33000999A104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No104100000XBehavioral Health & Social Service ProvidersSocial Worker