Provider Demographics
NPI:1811248867
Name:CERRO, JASON T (LPC)
Entity type:Individual
Prefix:
First Name:JASON
Middle Name:T
Last Name:CERRO
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 FIELDSTONE WAY
Mailing Address - Street 2:
Mailing Address - City:WESTERLY
Mailing Address - State:RI
Mailing Address - Zip Code:02891-2697
Mailing Address - Country:US
Mailing Address - Phone:401-524-5938
Mailing Address - Fax:
Practice Address - Street 1:3175 GOLD STAR HWY
Practice Address - Street 2:104, G3
Practice Address - City:MYSTIC
Practice Address - State:CT
Practice Address - Zip Code:06355-1200
Practice Address - Country:US
Practice Address - Phone:401-524-5938
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-29
Last Update Date:2012-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002261101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional