Provider Demographics
NPI:1386728392
Name:CERELLA, JANET (LICSW)
Entity type:Individual
Prefix:
First Name:JANET
Middle Name:
Last Name:CERELLA
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:38 POND ST STE 101
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:MA
Mailing Address - Zip Code:02038-3822
Mailing Address - Country:US
Mailing Address - Phone:508-528-6037
Mailing Address - Fax:508-520-6783
Practice Address - Street 1:38 POND ST STE 101
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:MA
Practice Address - Zip Code:02038-3822
Practice Address - Country:US
Practice Address - Phone:508-528-6037
Practice Address - Fax:508-520-6783
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2009-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR067398-11041C0700X
MA1102051041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WIRA1185Medicare ID - Type Unspecified