=====================================================
General NPI Number Information
=====================================================
NPI Number | 1972323509
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | PETER CERAVINO
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/17/2024
-----------------------------------------------------
Last Update Date | 10/17/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 17 HIGH ST
-----------------------------------------------------
City | NORWALK
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06851-4723
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 203-803-4170
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1 NORD CIR
-----------------------------------------------------
City | OSSINING
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10562-4005
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 914-648-8953
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number | 46.005272-ASOC
-----------------------------------------------------
License Number State | CT
-----------------------------------------------------