Provider Demographics
NPI:1750095642
Name:CELENTANO, JILLIAN RAE (MSW)
Entity type:Individual
Prefix:
First Name:JILLIAN
Middle Name:RAE
Last Name:CELENTANO
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:920 OCEAN AVE UNIT 2B
Mailing Address - Street 2:
Mailing Address - City:WEST HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06516-6456
Mailing Address - Country:US
Mailing Address - Phone:203-464-0511
Mailing Address - Fax:
Practice Address - Street 1:111 NEW HAVEN AVE
Practice Address - Street 2:
Practice Address - City:DERBY
Practice Address - State:CT
Practice Address - Zip Code:06418-2197
Practice Address - Country:US
Practice Address - Phone:475-439-9639
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-06
Last Update Date:2023-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT6865101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health