Healthcare Provider Details

I. General information

NPI: 1770694952
Provider Name (Legal Business Name): PAULINE CECERE LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9 ALBANY ST
CAZENOVIA NY
13035-1201
US

IV. Provider business mailing address

2929 HOLMES RD
CAZENOVIA NY
13035-9419
US

V. Phone/Fax

Practice location:
  • Phone: 315-655-3066
  • Fax: 315-662-3867
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number25958
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: