Provider Demographics
NPI:1588351399
Name:CERACEANU PETCU, CLAUDIA (MSW)
Entity type:Individual
Prefix:
First Name:CLAUDIA
Middle Name:
Last Name:CERACEANU PETCU
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:502 7TH ST NE
Mailing Address - Street 2:
Mailing Address - City:LITTLE FALLS
Mailing Address - State:MN
Mailing Address - Zip Code:56345-2807
Mailing Address - Country:US
Mailing Address - Phone:612-702-4767
Mailing Address - Fax:
Practice Address - Street 1:62 E BROADWAY STE 103
Practice Address - Street 2:
Practice Address - City:LITTLE FALLS
Practice Address - State:MN
Practice Address - Zip Code:56345-3047
Practice Address - Country:US
Practice Address - Phone:612-702-4767
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-20
Last Update Date:2023-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN31815104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker