Healthcare Provider Details

I. General information

NPI: 1164186029
Provider Name (Legal Business Name): CELSIUS NEUROPSYCHOLOGY, A PSYCHOLOGY CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/27/2021
Last Update Date: 10/27/2021
Certification Date: 10/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

754 THE ALAMEDA APT 4316
SAN JOSE CA
95126-3181
US

IV. Provider business mailing address

754 THE ALAMEDA APT 4316
SAN JOSE CA
95126-3181
US

V. Phone/Fax

Practice location:
  • Phone: 305-562-9432
  • Fax:
Mailing address:
  • Phone: 305-562-9432
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code103TP2701X
TaxonomyGroup Psychotherapy Psychologist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code103TR0400X
TaxonomyRehabilitation Psychologist
License Number
License Number State

VIII. Authorized Official

Name: DR. JENNIFER ANN BARTON
Title or Position: CLINICAL NEUROPSYCHOLOGIST
Credential: PSY.D.
Phone: 305-562-9432