Provider Demographics
NPI:1972529204
Name:REDLER, CELENA MARTINO (PSY D)
Entity Type:Individual
Prefix:
First Name:CELENA
Middle Name:MARTINO
Last Name:REDLER
Suffix:
Gender:F
Credentials:PSY D
Other - Prefix:
Other - First Name:CELENA
Other - Middle Name:
Other - Last Name:MARTINO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PSYD
Mailing Address - Street 1:30 BERGEN ST
Mailing Address - Street 2:ADMC 12 1205
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07107-3000
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:30 BERGEN ST
Practice Address - Street 2:ADMC 12 1205
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07107-3000
Practice Address - Country:US
Practice Address - Phone:973-972-0037
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2009-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ35SI00425100103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
Q59613Medicare UPIN
NJ096876Medicare ID - Type Unspecified