Provider Demographics
NPI:1134602725
Name:CELATA, JILL (LICSW)
Entity type:Individual
Prefix:
First Name:JILL
Middle Name:
Last Name:CELATA
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:333 HIGH PLAIN RD
Mailing Address - Street 2:
Mailing Address - City:ANDOVER
Mailing Address - State:MA
Mailing Address - Zip Code:01810-3264
Mailing Address - Country:US
Mailing Address - Phone:978-247-8604
Mailing Address - Fax:
Practice Address - Street 1:333 HIGH PLAIN RD
Practice Address - Street 2:
Practice Address - City:ANDOVER
Practice Address - State:MA
Practice Address - Zip Code:01810-3264
Practice Address - Country:US
Practice Address - Phone:978-247-8604
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-11
Last Update Date:2018-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool