Healthcare Provider Details

I. General information

NPI: 1942188446
Provider Name (Legal Business Name): CARA CERULLO LISW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/22/2025
Last Update Date: 07/06/2026
Certification Date: 07/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1299 BERKSHIRE LN
NORTH LIBERTY IA
52317-4894
US

IV. Provider business mailing address

1299 BERKSHIRE LN
NORTH LIBERTY IA
52317-4894
US

V. Phone/Fax

Practice location:
  • Phone: 319-231-8050
  • Fax:
Mailing address:
  • Phone: 319-231-8050
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number06527
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: