Provider Demographics
NPI:1902130610
Name:CERILLO, MARIE
Entity Type:Individual
Prefix:MS
First Name:MARIE
Middle Name:
Last Name:CERILLO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2021 RENOIR AVE
Mailing Address - Street 2:
Mailing Address - City:DAVIS
Mailing Address - State:CA
Mailing Address - Zip Code:95618-0512
Mailing Address - Country:US
Mailing Address - Phone:530-753-5040
Mailing Address - Fax:
Practice Address - Street 1:3331 POWER INN RD STE 170
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95826-3889
Practice Address - Country:US
Practice Address - Phone:916-876-7770
Practice Address - Fax:916-875-9970
Is Sole Proprietor?:No
Enumeration Date:2009-09-28
Last Update Date:2009-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA35723106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist