Healthcare Provider Details

I. General information

NPI: 1003365271
Provider Name (Legal Business Name): CELIA TEIRA SERRANO PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/28/2016
Last Update Date: 09/28/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1502 SPRUCE AVE
WILMINGTON DE
19805-2148
US

IV. Provider business mailing address

1708 N BROOM ST APT 2
WILMINGTON DE
19806-3071
US

V. Phone/Fax

Practice location:
  • Phone: 302-552-3797
  • Fax:
Mailing address:
  • Phone: 302-363-8218
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number86542
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: