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Organization
STEPHEN DI CERBO LMFT PA
Active
Organization
STEPHEN DI CERBO LMFT PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. STEPHEN DI CERBO LMFT (PRESIDENT)
(321) 848-3979
Entity
Organization
Contact information
Practice address
2781 MAJESTIC AVE, MELBOURNE, FL 32934-7574
(321) 848-3979
Mailing address
2781 MAJESTIC AVE, MELBOURNE, FL 32934-7574
(321) 848-3979
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
—
—
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
—
—
261QM0850X
Adult Mental Health Clinic/Center
—
—
261QM0855X
Adolescent and Children Mental Health Clinic/Center
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
015336400
—
FL
01
—
1114260064
NPI
—
01
—
12664043
CAQH
—
Enumeration date
04/24/2020
Last updated
06/14/2022
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