Healthcare Provider Details

I. General information

NPI: 1558844290
Provider Name (Legal Business Name): STEPHANIE A CERULLO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/10/2018
Last Update Date: 12/20/2024
Certification Date: 12/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6942 TYLERSVILLE RD
WEST CHESTER OH
45069-1511
US

IV. Provider business mailing address

1910 FAIRGROVE AVE STE E
HAMILTON OH
45011-1930
US

V. Phone/Fax

Practice location:
  • Phone: 513-868-0055
  • Fax:
Mailing address:
  • Phone: 513-795-7557
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberE.2404854
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: