Mind & Body Reboot, LLC

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

Legal business name

MIND & BODY REBOOT, LLC

Practice address

10 Gregory LN
Chester Springs, PA 19425-3314

Phone

(610) 465-7310

NPI assigned

Oct 5, 2021

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Lisa Cerrullo, PHD

Title

Founder

Phone

(610) 465-7310

Specialties & licenses 1

Addresses

Other identifiers 1

Electronic endpoints 1

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Lisa Cerullo, MSW, MHS

  • Addiction (Substance Use Disorder) Counselor
  • Chester Springs, PA
  • NPI 1205062510
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1633392000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1633392000000",
    "number": "1760144901",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10 GREGORY LN",
            "city": "CHESTER SPRINGS",
            "state": "PA",
            "postal_code": "194253314",
            "telephone_number": "610-213-4101"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10 GREGORY LN",
            "city": "CHESTER SPRINGS",
            "state": "PA",
            "postal_code": "194253314",
            "telephone_number": "610-465-7310"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MIND & BODY REBOOT, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-10-05",
        "last_updated": "2021-10-05",
        "certification_date": "2021-10-05",
        "status": "A",
        "authorized_official_last_name": "CERRULLO",
        "authorized_official_first_name": "LISA",
        "authorized_official_title_or_position": "FOUNDER",
        "authorized_official_telephone_number": "610-465-7310",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PHD"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HIGHMARK",
            "identifier": "1041C0700X",
            "state": "PA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "Simplepractice",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "10 Gregory Ln",
            "city": "Chester Springs",
            "state": "PA",
            "country_code": "US",
            "postal_code": "194253314",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Michelle Irene McKeon
• Karen Florence McMullen, CPC
• Sheree Aleta McMullen, LMT, PTA
• Mending Hearts and Minds Therapy Services
• Amy Marie Mermelstein, MS, CCC-SLP
• Anjum Mohammad, FNP-BC
• Patricia Taylor Molloy, MD
• Stephanie M. Muntzer, PT, MPT
• Myeyedr Optometry of Pennsylvania, LLC
• Darab Nasserzad

• All providers in Chester Springs, PA
• Clinical Social Worker in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 5, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.