MEDICARE: MR. JOHN L CELLA LCSW

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	1041C0700X	Clinical Social Worker	R0241891	NY

General Provider Information

NPI Number	:	1487780730
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JOHN L CELLA LCSW

Provider Business Mailing Address
First Line	:	2336 RICHMOND ROAD
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10306
Country	:	US
Telephone Number	:	718-787-3643
Fax Number	:

Provider Business Practice Location Address
First Line	:	2336 RICHMOND ROAD
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10306
Country	:	US
Telephone Number	:	718-787-3643
Fax Number	:

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

Provider Enumeration Date	:	02/23/2007
Last Update Date	:	07/08/2007

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