Healthcare Provider Details

I. General information

NPI: 1558947655
Provider Name (Legal Business Name): LAUREN CELENTANO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2021
Last Update Date: 07/28/2026
Certification Date: 07/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1611 NW 12TH AVE
MIAMI FL
33136-1096
US

IV. Provider business mailing address

441 VALENCIA AVE PH
CORAL GABLES FL
33134-5798
US

V. Phone/Fax

Practice location:
  • Phone: 954-461-6776
  • Fax:
Mailing address:
  • Phone: 954-461-6776
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberME167755
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: