Provider Demographics
NPI:1144549585
Name:CHILELLI, JUSTINE SEVER (DO)
Entity type:Individual
Prefix:
First Name:JUSTINE
Middle Name:SEVER
Last Name:CHILELLI
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 HOME RD
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:41011-1942
Mailing Address - Country:US
Mailing Address - Phone:592-618-7688
Mailing Address - Fax:859-291-2431
Practice Address - Street 1:525 W 5TH ST STE 219
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:KY
Practice Address - Zip Code:41011-1293
Practice Address - Country:US
Practice Address - Phone:859-261-8768
Practice Address - Fax:859-291-2431
Is Sole Proprietor?:No
Enumeration Date:2010-05-25
Last Update Date:2024-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY042022084P0800X, 2084P0804X
FLOS115802084P0800X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0188337Medicaid
KY7100464370Medicaid