Provider Demographics
NPI:1487742573
Name:CERVIN, JEANNE KAREN (RN, MS, APRNBC)
Entity type:Individual
Prefix:MS
First Name:JEANNE
Middle Name:KAREN
Last Name:CERVIN
Suffix:
Gender:F
Credentials:RN, MS, APRNBC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06460-4705
Mailing Address - Country:US
Mailing Address - Phone:203-878-1665
Mailing Address - Fax:
Practice Address - Street 1:1 KINGS HWY N
Practice Address - Street 2:
Practice Address - City:WESTPORT
Practice Address - State:CT
Practice Address - Zip Code:06880-3000
Practice Address - Country:US
Practice Address - Phone:203-454-7688
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTR26119101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health