Keri Denise Cezario, RADT1

Primary specialty

Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X

License

R1534321023 Issued in CA

Practice address

733 Cedar St
Garberville, CA 95542-3201

Phone

(707) 923-2931

NPI assigned

May 15, 2024

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other names 1

• Mrs. Keri Denise Clock Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1715731200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1715731200000",
    "number": "1992554620",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1831 KELLI WAY",
            "city": "FORTUNA",
            "state": "CA",
            "postal_code": "955403279",
            "telephone_number": "707-223-3450"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "733 CEDAR ST",
            "city": "GARBERVILLE",
            "state": "CA",
            "postal_code": "955423201",
            "telephone_number": "707-923-2931"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CEZARIO",
        "first_name": "KERI",
        "middle_name": "DENISE",
        "name_prefix": "Mrs.",
        "credential": "RADT1",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2024-05-15",
        "last_updated": "2024-05-15",
        "certification_date": "2024-05-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "CA",
            "license": "R1534321023",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KERI",
            "last_name": "CLOCK",
            "middle_name": "DENISE",
            "prefix": "MRS.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

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• Addiction (Substance Use Disorder) Counselor in Garberville, CA
• Providers in Garberville, CA by specialty
• Addiction (Substance Use Disorder) Counselor in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 15, 2024; 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.