MEDICARE: MS. LISA CERULLO MSW, MHS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor

General Provider Information

NPI Number	:	1205062510
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. LISA CERULLO MSW, MHS

Provider Business Mailing Address
First Line	:	10 GREGORY LN
Second Line	:
City	:	CHESTER SPRINGS
State	:	PA
Zip	:	19425-3314
Country	:	US
Telephone Number	:	610-213-4101
Fax Number	:

Provider Business Practice Location Address
First Line	:	10 GREGORY LN
Second Line	:
City	:	CHESTER SPRINGS
State	:	PA
Zip	:	19425-3314
Country	:	US
Telephone Number	:	610-213-4101
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/02/2009
Last Update Date	:	06/02/2009

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