Provider Demographics
NPI:1851020341
Name:EWING, CELESTE (RBT)
Entity Type:Individual
Prefix:
First Name:CELESTE
Middle Name:
Last Name:EWING
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20546 POLYNESIAN LOOP
Mailing Address - Street 2:
Mailing Address - City:ESTERO
Mailing Address - State:FL
Mailing Address - Zip Code:33928-2706
Mailing Address - Country:US
Mailing Address - Phone:765-480-2921
Mailing Address - Fax:
Practice Address - Street 1:708 GOODLETTE-FRANK RD N
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34102-5644
Practice Address - Country:US
Practice Address - Phone:239-351-0675
Practice Address - Fax:393-102-0452
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-09
Last Update Date:2022-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
INRBT-22-218711106S00000X
FLRBT-22-218711106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician