Basic Information
| Provider Information | |||||||||
| NPI: | 1043808405 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CERAOLO | ||||||||
| FirstName: | MAXINE | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | ARNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2816 MAYFIELD RD APT 204 | ||||||||
| Address2: | |||||||||
| City: | CLEVELAND HEIGHTS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 441185209 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 240 W FRONT ST | ||||||||
| Address2: | |||||||||
| City: | PORT ANGELES | ||||||||
| State: | WA | ||||||||
| PostalCode: | 983622609 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3604527891 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/31/2020 | ||||||||
| LastUpdateDate: | 11/11/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 11/11/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163WP0808X | 417174 | OH | N | Nursing Service Providers | Registered Nurse | Psych/Mental Health | 363LP0808X | AP61167344 | WA | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Psych/Mental Health | 103T00000X | AP61167344 | WA | Y | Behavioral Health & Social Service Providers | Psychologist |
No ID Information.