Provider Demographics
NPI:1912109182
Name:CIERVO, JOHN J (CAGS, LSW, LMHC)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:J
Last Name:CIERVO
Suffix:
Gender:M
Credentials:CAGS, LSW, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 CERDAN AVE
Mailing Address - Street 2:
Mailing Address - City:WEST ROXBURY
Mailing Address - State:MA
Mailing Address - Zip Code:02132-7811
Mailing Address - Country:US
Mailing Address - Phone:617-901-5219
Mailing Address - Fax:
Practice Address - Street 1:40 CERDAN AVE
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02132-7811
Practice Address - Country:US
Practice Address - Phone:617-901-5219
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-01
Last Update Date:2009-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health