Healthcare Provider Details

I. General information

NPI: 1235803842
Provider Name (Legal Business Name): TESSAROSE CEPE BROWN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: TESSAROSE BAUTISTA CEPE

II. Dates (important events)

Enumeration Date: 08/06/2021
Last Update Date: 09/01/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

220 S BREIEL BLVD STE D
MIDDLETOWN OH
45044-5167
US

IV. Provider business mailing address

250 W LAKE RD
RAEFORD NC
28376-6617
US

V. Phone/Fax

Practice location:
  • Phone: 910-605-3472
  • Fax:
Mailing address:
  • Phone: 619-208-3855
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number11963
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: