Healthcare Provider Details

I. General information

NPI: 1811253941
Provider Name (Legal Business Name): JESSICA L CERUTTI LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/03/2012
Last Update Date: 03/22/2022
Certification Date: 03/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

156 MAIN ST
BINGHAMTON NY
13905-2611
US

IV. Provider business mailing address

165 MAIN ST STE A
CORTLAND NY
13045-3191
US

V. Phone/Fax

Practice location:
  • Phone: 607-729-6206
  • Fax:
Mailing address:
  • Phone: 77-530-2346
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number086114-1
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number092070
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: