Provider Demographics
NPI:1417453838
Name:SANTIVASCI, CELESTE ANGELINA
Entity Type:Individual
Prefix:MISS
First Name:CELESTE
Middle Name:ANGELINA
Last Name:SANTIVASCI
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 1:186 E 13TH AVE
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43201-1810
Mailing Address - Country:US
Mailing Address - Phone:330-410-6731
Mailing Address - Fax:
Practice Address - Street 1:6601 DUBLIN CENTER DR
Practice Address - Street 2:
Practice Address - City:DUBLIN
Practice Address - State:OH
Practice Address - Zip Code:43017-5077
Practice Address - Country:US
Practice Address - Phone:614-253-6933
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-04
Last Update Date:2018-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH990403055739OtherMEDICAL MUTUAL