Provider Demographics
NPI:1336794379
Name:CERASO, CHRISTY
Entity type:Individual
Prefix:
First Name:CHRISTY
Middle Name:
Last Name:CERASO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13-125 PUAKENIKENI PL
Mailing Address - Street 2:
Mailing Address - City:PAHOA
Mailing Address - State:HI
Mailing Address - Zip Code:96778-8052
Mailing Address - Country:US
Mailing Address - Phone:808-338-2313
Mailing Address - Fax:762-220-1801
Practice Address - Street 1:13-125 PUAKENIKENI PL
Practice Address - Street 2:
Practice Address - City:PAHOA
Practice Address - State:HI
Practice Address - Zip Code:96778-8052
Practice Address - Country:US
Practice Address - Phone:808-338-2313
Practice Address - Fax:762-220-1801
Is Sole Proprietor?:No
Enumeration Date:2019-08-06
Last Update Date:2022-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor