MEDICARE: DR. MARK A CELIO PHD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TA0400X	Addiction (Substance Use Disorder) Psychologist
2	103TB0200X	Cognitive & Behavioral Psychologist
3	103TC0700X	Clinical Psychologist	PS01682	RI

General Provider Information

NPI Number	:	1033675145
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARK A CELIO PHD

Provider Business Mailing Address
First Line	:	6 FENWICK RD
Second Line	:
City	:	RIVERSIDE
State	:	RI
Zip	:	02915-1420
Country	:	US
Telephone Number	:	401-497-7884
Fax Number	:

Provider Business Practice Location Address
First Line	:	121 S MAIN ST
Second Line	:
City	:	PROVIDENCE
State	:	RI
Zip	:	02903-2905
Country	:	US
Telephone Number	:	401-863-6662
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/13/2019
Last Update Date	:	02/13/2019

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Directions to “ DR. MARK A CELIO PHD” Practice Location

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