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General NPI Number Information
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NPI Number | 1285188896
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Entity Type | Organization
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Legal Business Name | JESSICA CERUTTI, LCSW
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Dates
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Enumeration Date | 08/11/2016
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Last Update Date | 08/11/2016
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Provider Practice Location Address
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Address Line | 254 S DE LACEY AVE SUITE B
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City | PASADENA
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State | CA
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Zip | 91105-2006
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Country | US
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Telephone | 626-559-0552
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Fax | 323-430-8878
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Provider Business Mailing Address
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Address Line | 254 S DE LACEY AVE SUITE B
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City | PASADENA
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State | CA
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Zip | 91105-2006
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Country | US
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Telephone | 626-559-0552
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Fax | 323-430-8878
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Authorized Official
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Title or Position | OWNER
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Name | JESSICA CERUTTI
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Credential | LCSW
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Telephone | 626-559-0552
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | LCS29869
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License Number State | CA
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