Healthcare Provider Details

I. General information

NPI: 1982979324
Provider Name (Legal Business Name): THERESA JEANNE CERBONE LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/19/2012
Last Update Date: 03/19/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1680 ALBANY AVE
HARTFORD CT
06105-1001
US

IV. Provider business mailing address

1680 ALBANY AVE
HARTFORD CT
06105-1001
US

V. Phone/Fax

Practice location:
  • Phone: 860-297-0554
  • Fax: 860-523-0346
Mailing address:
  • Phone: 860-297-0554
  • Fax: 860-523-0346

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number007319
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: