Healthcare Provider Details

I. General information

NPI: 1609795723
Provider Name (Legal Business Name): CELESTE ANTONIA TRACEY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2026
Last Update Date: 07/13/2026
Certification Date: 07/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1124 PATRIOT WAY
EASTAMPTON NJ
08060-9624
US

IV. Provider business mailing address

16 EASTBROOK LN
WILLINGBORO NJ
08046-2258
US

V. Phone/Fax

Practice location:
  • Phone: 856-432-1355
  • Fax: 856-291-7414
Mailing address:
  • Phone: 856-432-1355
  • Fax: 856-291-7414

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-26-508537
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: