Provider Demographics
NPI:1356337620
Name:CERRA, VICTOR (EDD)
Entity type:Individual
Prefix:DR
First Name:VICTOR
Middle Name:
Last Name:CERRA
Suffix:
Gender:M
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 12TH ST
Mailing Address - Street 2:SUITE 222
Mailing Address - City:WHEELING
Mailing Address - State:WV
Mailing Address - Zip Code:26003-3279
Mailing Address - Country:US
Mailing Address - Phone:304-232-0190
Mailing Address - Fax:304-232-4682
Practice Address - Street 1:40 12TH ST
Practice Address - Street 2:SUITE 222
Practice Address - City:WHEELING
Practice Address - State:WV
Practice Address - Zip Code:26003-3279
Practice Address - Country:US
Practice Address - Phone:304-232-0190
Practice Address - Fax:304-232-4682
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-22
Last Update Date:2011-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV148103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV550709943OtherFEIN
WV0162855000Medicaid
WV550709943OtherFEIN