Provider Demographics
NPI:1407341670
Name:CERBO, NICHOLAS (PSYD)
Entity type:Individual
Prefix:DR
First Name:NICHOLAS
Middle Name:
Last Name:CERBO
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:117 ELLENFIELD ST
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02905-4541
Mailing Address - Country:US
Mailing Address - Phone:401-444-6966
Mailing Address - Fax:401-444-6912
Practice Address - Street 1:19 FRIENDSHIP ST UNIT 340
Practice Address - Street 2:
Practice Address - City:NEWPORT
Practice Address - State:RI
Practice Address - Zip Code:02840-2200
Practice Address - Country:US
Practice Address - Phone:401-845-4340
Practice Address - Fax:401-845-4349
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-28
Last Update Date:2024-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIPS02257103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical