| Entity Name: | STEPHEN DI CERBO LMFT PA |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Active |
| Date Filed: | 25 Jan 2017 (8 years ago) |
| Document Number: | P17000008874 |
| FEI/EIN Number | 81-2055641 |
| Address: | 2781 Majestic Ave., MELBOURNE, FL, 32934, US |
| Mail Address: | 2781 Majestic Ave., MELBOURNE, FL, 32934, US |
| ZIP code: | 32934 |
| County: | Brevard |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1720608219 | 2020-04-24 | 2022-06-14 | 2781 MAJESTIC AVE, MELBOURNE, FL, 329347574, US | 2781 MAJESTIC AVE, MELBOURNE, FL, 329347574, US | |||||||||||||||||||||||||||||||||||||||
|
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| Phone | +1 321-848-3979 |
Authorized person
| Name | MR. STEPHEN DI CERBO |
| Role | PRESIDENT |
| Phone | 3218483979 |
Taxonomy
| Taxonomy Code | 251S00000X - Community/Behavioral Health Agency |
| Is Primary | No |
| Taxonomy Code | 261QM0801X - Mental Health Clinic/Center (Including Community Mental Health Center) |
| Is Primary | Yes |
| Taxonomy Code | 261QM0850X - Adult Mental Health Clinic/Center |
| Is Primary | No |
| Taxonomy Code | 261QM0855X - Adolescent and Children Mental Health Clinic/Center |
| Is Primary | No |
Other Provider Identifiers
| Issuer | CAQH |
| Number | 12664043 |
| Issuer | MEDICAID |
| Number | 015336400 |
| State | FL |
| Issuer | NPI |
| Number | 1114260064 |
| Name | Role | Address |
|---|---|---|
| DI CERBO STEPHEN | Agent | 2781 Majestic Ave., MELBOURNE, FL, 32934 |
| Name | Role | Address |
|---|---|---|
| DI CERBO STEPHEN W | President | 2781 Majestic Ave., MELBOURNE, FL, 32934 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2018-03-29 | 2781 Majestic Ave., MELBOURNE, FL 32934 | No data |
| CHANGE OF MAILING ADDRESS | 2018-03-29 | 2781 Majestic Ave., MELBOURNE, FL 32934 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2018-03-29 | 2781 Majestic Ave., MELBOURNE, FL 32934 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-03-17 |
| ANNUAL REPORT | 2023-03-28 |
| ANNUAL REPORT | 2022-04-11 |
| ANNUAL REPORT | 2021-03-17 |
| ANNUAL REPORT | 2020-05-15 |
| ANNUAL REPORT | 2019-03-11 |
| ANNUAL REPORT | 2018-03-29 |
| Domestic Profit | 2017-01-25 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
