Basic Information
| Provider Information | |||||||||
| NPI: | 1669791315 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CERCONE | ||||||||
| FirstName: | SARAH | ||||||||
| MiddleName: | E.B. | ||||||||
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| Credential: | LSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6505 MARKET ST | ||||||||
| Address2: | |||||||||
| City: | BOARDMAN | ||||||||
| State: | OH | ||||||||
| PostalCode: | 445123457 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3305435015 | ||||||||
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| Practice Location | |||||||||
| Address1: | 711 BELMONT AVE | ||||||||
| Address2: | |||||||||
| City: | YOUNGSTOWN | ||||||||
| State: | OH | ||||||||
| PostalCode: | 445021039 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3307932487 | ||||||||
| FaxNumber: | 3307435748 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/20/2010 | ||||||||
| LastUpdateDate: | 03/12/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/12/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | N | Behavioral Health & Social Service Providers | Counselor | Mental Health | 101YP2500X | S.1701133 | OH | N | Behavioral Health & Social Service Providers | Counselor | Professional | 103K00000X | N | Behavioral Health & Social Service Providers | Behavioral Analyst | 1041C0700X | I.1901855 | OH | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.