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General NPI Number Information
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NPI Number | 1497076848
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Entity Type | Individual
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Provider Name | GINA MARIE CERMINARA LPC
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Gender | Female
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Dates
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Enumeration Date | 06/21/2010
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Last Update Date | 09/22/2011
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Provider Practice Location Address
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Address Line | 5801 WASHINGTON AVENUE SUITE 110
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City | RACINE
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State | WI
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Zip | 53406
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Country | US
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Telephone | 262-884-9734
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Fax | 262-884-9735
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Provider Business Mailing Address
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Address Line | 5801 WASHINGTON AVE SUITE 110
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City | MOUNT PLEASANT
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State | WI
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Zip | 53406-4057
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Country | US
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Telephone | 262-884-9734
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Fax | 262-884-9735
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 4249
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License Number State | WI
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