Provider Demographics
NPI:1568663219
Name:CELESTIAL, JEANNIE E (PHD)
Entity Type:Individual
Prefix:DR
First Name:JEANNIE
Middle Name:E
Last Name:CELESTIAL
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1727 MARTIN LUTHER KING JR WAY
Mailing Address - Street 2:SUITE 19
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94612-1358
Mailing Address - Country:US
Mailing Address - Phone:510-893-9230
Mailing Address - Fax:510-893-2074
Practice Address - Street 1:1761 BROADWAY ST STE 100
Practice Address - Street 2:
Practice Address - City:VALLEJO
Practice Address - State:CA
Practice Address - Zip Code:94589-2227
Practice Address - Country:US
Practice Address - Phone:707-645-2700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-30
Last Update Date:2018-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAASW 154251041C0700X
CA29740103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical