Provider Demographics
NPI:1407564198
Name:CELAYA, VERONIKA
Entity Type:Individual
Prefix:
First Name:VERONIKA
Middle Name:
Last Name:CELAYA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 QUEENS DR APT D
Mailing Address - Street 2:
Mailing Address - City:HUDSON FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:12839-6627
Mailing Address - Country:US
Mailing Address - Phone:315-560-3209
Mailing Address - Fax:
Practice Address - Street 1:25 WILLOWBROOK RD
Practice Address - Street 2:
Practice Address - City:QUEENSBURY
Practice Address - State:NY
Practice Address - Zip Code:12804-5882
Practice Address - Country:US
Practice Address - Phone:518-926-7100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-10
Last Update Date:2022-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty