MEDICARE: MRS. VIRGINIA M CERBO LICSW

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	104100000X	Social Worker	LSW00275	RI
2	1041C0700X	Clinical Social Worker	102077	MA
3	1041C0700X	Clinical Social Worker	ISW00275	RI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	406364	OTHER	RI	BLUE CHIP
2	7503001	OTHER		MASS BLT
3	75035	OTHER	RI	BLT
4	774623	OTHER		TUFTS

General Provider Information

NPI Number	:	1336248442
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. VIRGINIA M CERBO LICSW

Provider Business Mailing Address
First Line	:	PO BOX 233
Second Line	:
City	:	TIVERTON
State	:	RI
Zip	:	02878-0233
Country	:	US
Telephone Number	:	401-447-1544
Fax Number	:	--

Provider Business Practice Location Address
First Line	:	546 MAIN RD
Second Line	:
City	:	TIVERTON
State	:	RI
Zip	:	02878-1350
Country	:	US
Telephone Number	:	401-447-1544
Fax Number	:	--

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

Provider Enumeration Date	:	09/22/2006
Last Update Date	:	11/16/2025

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Directions to “ MRS. VIRGINIA M CERBO LICSW” Practice Location

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