MEDICARE: DR. BRIAN GERARD CELSO 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	103T00000X	Psychologist	PY6042	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1235102732
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BRIAN GERARD CELSO PHD.

Provider Business Mailing Address
First Line	:	2775 SAINT JOHNS AVE APT 5
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32205-8260
Country	:	US
Telephone Number	:	904-210-1130
Fax Number	:

Provider Business Practice Location Address
First Line	:	2775 SAINT JOHNS AVE APT 5
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32205-8260
Country	:	US
Telephone Number	:	904-210-1130
Fax Number	:

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

Provider Enumeration Date	:	02/07/2006
Last Update Date	:	01/16/2026

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