Healthcare Provider Details

I. General information

NPI: 1982935201
Provider Name (Legal Business Name): CELESTE H FROEHLICH LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/26/2010
Last Update Date: 10/18/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

215 N GENEVA ST
ITHACA NY
14850-4166
US

IV. Provider business mailing address

306 ELM ST
ITHACA NY
14850-3019
US

V. Phone/Fax

Practice location:
  • Phone: 607-218-2922
  • Fax:
Mailing address:
  • Phone: 607-218-2922
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: