Provider Demographics
NPI:1407036791
Name:CELEBRE, GERALD (EDD)
Entity Type:Individual
Prefix:DR
First Name:GERALD
Middle Name:
Last Name:CELEBRE
Suffix:
Gender:M
Credentials:EDD
Other - Prefix:DR
Other - First Name:JOHN
Other - Middle Name:GERALD
Other - Last Name:CELEBRE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:EDD
Mailing Address - Street 1:4851 INDEPENDENCE ST
Mailing Address - Street 2:
Mailing Address - City:WHEAT RIDGE
Mailing Address - State:CO
Mailing Address - Zip Code:80033-6715
Mailing Address - Country:US
Mailing Address - Phone:303-425-0300
Mailing Address - Fax:303-432-5071
Practice Address - Street 1:12055 W 2ND PL
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80228-1506
Practice Address - Country:US
Practice Address - Phone:303-425-4480
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-11-05
Last Update Date:2021-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPSY.0003073103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
COCOA105814OtherMEDICARE INDIVIDUAL PTAN