Healthcare Provider Details

I. General information

NPI: 1356286728
Provider Name (Legal Business Name): TIARA CELESTINE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/22/2026
Last Update Date: 04/22/2026
Certification Date: 04/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4215 PARK AVE
BRONX NY
10457-6073
US

IV. Provider business mailing address

4215 PARK AVE APT 3J
BRONX NY
10457-6050
US

V. Phone/Fax

Practice location:
  • Phone: 347-593-9589
  • Fax:
Mailing address:
  • Phone: 347-593-9589
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number129601
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: