Provider Demographics
NPI:1043561954
Name:JOHNSON, CELESTE (MPA, BS)
Entity Type:Individual
Prefix:
First Name:CELESTE
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:MPA, BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1569 BRUCKNER BLVD
Mailing Address - Street 2:APT 3G
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10472-6426
Mailing Address - Country:US
Mailing Address - Phone:347-590-0392
Mailing Address - Fax:
Practice Address - Street 1:1569 BRUCKNER BLVD
Practice Address - Street 2:APT 3G
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10472-6426
Practice Address - Country:US
Practice Address - Phone:347-590-0392
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-02
Last Update Date:2012-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator