Healthcare Provider Details

I. General information

NPI: 1053696062
Provider Name (Legal Business Name): CELESTIN AQUINO BA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/21/2011
Last Update Date: 10/21/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

521 W 239TH ST
BRONX NY
10463-1205
US

IV. Provider business mailing address

3206 FAIRFIELD AVE
BRONX NY
10463-3270
US

V. Phone/Fax

Practice location:
  • Phone: 718-601-2280
  • Fax: 718-601-2281
Mailing address:
  • Phone: 718-601-4111
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: