Healthcare Provider Details

I. General information

NPI: 1376649467
Provider Name (Legal Business Name): MARIANNE CELANO PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/15/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

THE EMORY CLINIC DEPARTMENT OF PSYCHIATRY 1365 CLIFTON ROAD, SUITE B-6100
ATLANTA GA
30322-0001
US

IV. Provider business mailing address

THE EMORY CLINIC DEPARTMENT OF PSYCHIATRY 1365 CLIFTON ROAD, SUITE B-6100
ATLANTA GA
30322-0001
US

V. Phone/Fax

Practice location:
  • Phone: 404-778-5526
  • Fax: 404-778-4655
Mailing address:
  • Phone: 404-778-5526
  • Fax: 404-778-4655

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number1369
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: