Provider Demographics
NPI:1487936936
Name:CETRULO, JEANNE C (LPCC)
Entity type:Individual
Prefix:
First Name:JEANNE
Middle Name:C
Last Name:CETRULO
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:JEANNE
Other - Middle Name:
Other - Last Name:GOINS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 16199
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88004-6199
Mailing Address - Country:US
Mailing Address - Phone:575-527-5770
Mailing Address - Fax:575-532-1928
Practice Address - Street 1:217 PASEO DEL PUEBLO NORTE STE E
Practice Address - Street 2:
Practice Address - City:TAOS
Practice Address - State:NM
Practice Address - Zip Code:87571-5963
Practice Address - Country:US
Practice Address - Phone:575-825-3522
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-11
Last Update Date:2023-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM0142621101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM31306560Medicaid