Provider Demographics
NPI:1417460049
Name:CELESTINO, TINA (LADC)
Entity Type:Individual
Prefix:
First Name:TINA
Middle Name:
Last Name:CELESTINO
Suffix:
Gender:F
Credentials:LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 CORLISS LN
Mailing Address - Street 2:
Mailing Address - City:CHESHIRE
Mailing Address - State:CT
Mailing Address - Zip Code:06410-3710
Mailing Address - Country:US
Mailing Address - Phone:203-444-9156
Mailing Address - Fax:
Practice Address - Street 1:48 HOWE ST
Practice Address - Street 2:
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06511-4620
Practice Address - Country:US
Practice Address - Phone:203-624-2525
Practice Address - Fax:203-397-9077
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-06
Last Update Date:2017-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)