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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