Provider Demographics
NPI:1215225602
Name:CEBOLLERO, ALBERTO RAMON (PHD)
Entity type:Individual
Prefix:DR
First Name:ALBERTO
Middle Name:RAMON
Last Name:CEBOLLERO
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1615 CRITTENDEN RD
Mailing Address - Street 2:APT. 1
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14623-2359
Mailing Address - Country:US
Mailing Address - Phone:978-424-1790
Mailing Address - Fax:
Practice Address - Street 1:402 ROGERS PARKWAY
Practice Address - Street 2:THE KESSLER CENTER
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14617
Practice Address - Country:US
Practice Address - Phone:585-957-7158
Practice Address - Fax:585-266-8518
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-19
Last Update Date:2012-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY015540-1103TC0700X
MI6301014403103TC0700X
NH1224103TC0700X
NH82115103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool