Provider Demographics
NPI:1447012521
Name:CERVERO, STEFANIE (LMSW, LADC)
Entity type:Individual
Prefix:
First Name:STEFANIE
Middle Name:
Last Name:CERVERO
Suffix:
Gender:F
Credentials:LMSW, LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:76 LANTERN PARK DR UNIT 2
Mailing Address - Street 2:
Mailing Address - City:NAUGATUCK
Mailing Address - State:CT
Mailing Address - Zip Code:06770-1842
Mailing Address - Country:US
Mailing Address - Phone:035-929-9629
Mailing Address - Fax:
Practice Address - Street 1:1098 FARMINGTON AVE
Practice Address - Street 2:
Practice Address - City:BRISTOL
Practice Address - State:CT
Practice Address - Zip Code:06010-4705
Practice Address - Country:US
Practice Address - Phone:860-973-0209
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-25
Last Update Date:2024-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT7317101YA0400X
CT1567101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)