MEDICARE: MS. CELESTE FAVOR PSYCHA

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	103T00000X	Psychologist	PSYA200001710	DC

General Provider Information

NPI Number	:	1184577769
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. CELESTE FAVOR PSYCHA

Provider Business Mailing Address
First Line	:	4128 3RD ST NW
Second Line	:
City	:	WASHINGTON
State	:	DC
Zip	:	20011-4806
Country	:	US
Telephone Number	:	202-271-0784
Fax Number	:

Provider Business Practice Location Address
First Line	:	4128 3RD ST NW
Second Line	:
City	:	WASHINGTON
State	:	DC
Zip	:	20011-4806
Country	:	US
Telephone Number	:	202-271-0784
Fax Number	:

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

Provider Enumeration Date	:	02/16/2026
Last Update Date	:	02/16/2026

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Directions to “ MS. CELESTE FAVOR PSYCHA” Practice Location

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