Provider Demographics
NPI:1649095068
Name:CELENTANO, JESSE MATTHEW (LAC)
Entity type:Individual
Prefix:
First Name:JESSE
Middle Name:MATTHEW
Last Name:CELENTANO
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:764 MEMORIAL PKWY
Mailing Address - Street 2:
Mailing Address - City:PHILLIPSBURG
Mailing Address - State:NJ
Mailing Address - Zip Code:08865-2750
Mailing Address - Country:US
Mailing Address - Phone:908-329-2700
Mailing Address - Fax:908-329-2704
Practice Address - Street 1:764 MEMORIAL PKWY
Practice Address - Street 2:
Practice Address - City:PHILLIPSBURG
Practice Address - State:NJ
Practice Address - Zip Code:08865-2750
Practice Address - Country:US
Practice Address - Phone:908-329-2700
Practice Address - Fax:908-329-2704
Is Sole Proprietor?:No
Enumeration Date:2024-11-20
Last Update Date:2024-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37AC00712600106H00000X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist