Provider Demographics
NPI:1093754509
Name:CAMPBELL, CELESTE ANNE (PSY D)
Entity Type:Individual
Prefix:DR
First Name:CELESTE
Middle Name:ANNE
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:PSY D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:WASHINGTON VAMC
Mailing Address - Street 2:50 IRVING ST NW 3D-207
Mailing Address - City:WASHNGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20422-0001
Mailing Address - Country:US
Mailing Address - Phone:202-745-8000
Mailing Address - Fax:
Practice Address - Street 1:WASHINGTON VAMC
Practice Address - Street 2:50 IRVING ST NW 3D-207
Practice Address - City:WASHNGTON
Practice Address - State:DC
Practice Address - Zip Code:20422-0001
Practice Address - Country:US
Practice Address - Phone:202-745-8000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2008-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810001978103G00000X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA7700873Medicaid
017910SC34Medicare ID - Type Unspecified
522131Medicare UPIN