Provider Demographics
NPI:1811259567
Name:CELOTTI, LUCIANNA (BS)
Entity type:Individual
Prefix:MS
First Name:LUCIANNA
Middle Name:
Last Name:CELOTTI
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 217
Mailing Address - Street 2:
Mailing Address - City:ELIZABETHTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:12932-0217
Mailing Address - Country:US
Mailing Address - Phone:518-873-3513
Mailing Address - Fax:518-873-3863
Practice Address - Street 1:132 WATER STREET
Practice Address - Street 2:
Practice Address - City:ELIZABETHTOWN
Practice Address - State:NY
Practice Address - Zip Code:12932-0217
Practice Address - Country:US
Practice Address - Phone:518-873-3513
Practice Address - Fax:518-873-3863
Is Sole Proprietor?:No
Enumeration Date:2012-06-08
Last Update Date:2012-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00473721Medicaid