Provider Demographics
NPI:1124761663
Name:CERULLO, MADELIN DEE (LMHC)
Entity type:Individual
Prefix:
First Name:MADELIN
Middle Name:DEE
Last Name:CERULLO
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:MADELIN
Other - Middle Name:D
Other - Last Name:CERULLO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMHC
Mailing Address - Street 1:49 WALTHAM ST
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:02421-5418
Mailing Address - Country:US
Mailing Address - Phone:800-695-7775
Mailing Address - Fax:800-695-7775
Practice Address - Street 1:49 WALTHAM ST
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:MA
Practice Address - Zip Code:02421-5418
Practice Address - Country:US
Practice Address - Phone:800-695-7775
Practice Address - Fax:800-695-7775
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-13
Last Update Date:2022-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA12346101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA12346OtherLMHC LICENSE