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General NPI Number Information
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NPI Number | 1134878911
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Entity Type | Individual
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Provider Name | ISOBELLA PERSEPHONE CERCEO
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Gender | Female
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Dates
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Enumeration Date | 03/21/2022
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Last Update Date | 09/22/2022
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Provider Practice Location Address
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Address Line | 6690 HAUSER RD APT E206
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City | MACUNGIE
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State | PA
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Zip | 18062-8110
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Country | US
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Telephone | 727-477-2790
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Fax |
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Provider Business Mailing Address
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Address Line | 3440 LEHIGH ST
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City | ALLENTOWN
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State | PA
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Zip | 18103-7001
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Country | US
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Telephone | 727-477-2790
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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