Healthcare Provider Details

I. General information

NPI: 1487579645
Provider Name (Legal Business Name): CHERIE ANN CIMINO APCC 18328
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/13/2026
Last Update Date: 08/13/2026
Certification Date: 08/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 UNION AVE
FAIRFIELD CA
94533-6300
US

IV. Provider business mailing address

4789 MONTECITO AVE
SANTA ROSA CA
95404-1935
US

V. Phone/Fax

Practice location:
  • Phone: 707-784-7100
  • Fax:
Mailing address:
  • Phone: 831-818-1896
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberAPCC
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: