Provider Demographics
NPI:1811077035
Name:CERIO & CERIO PSYCHOLOGISTS, P.A.
Entity type:Organization
Organization Name:CERIO & CERIO PSYCHOLOGISTS, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY/TREASURER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:E
Authorized Official - Last Name:CERIO
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:315-854-6074
Mailing Address - Street 1:PO BOX 782
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:NY
Mailing Address - Zip Code:13617-0782
Mailing Address - Country:US
Mailing Address - Phone:315-854-6074
Mailing Address - Fax:315-714-3146
Practice Address - Street 1:91 MAIN ST
Practice Address - Street 2:SUITE 200
Practice Address - City:CANTON
Practice Address - State:NY
Practice Address - Zip Code:13617-1248
Practice Address - Country:US
Practice Address - Phone:315-854-6074
Practice Address - Fax:315-714-3146
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-16
Last Update Date:2014-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD2110103TC0700X
NY019159103TC0700X
NY019160103TC0700X
MD1859103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDK029Medicare ID - Type Unspecified