Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 103TA0400X | Addiction Psychologist (Substance Use Disorder) | ||
N | 103TB0200X | Cognitive & Behavioral Psychologist | ||
Y | 103G00000X | Clinical Psychologist | PS01682 | RI |
Y | 103TC0700X | Clinical Psychologist | PS01682 | RI |
NPI | 1033675145 |
---|---|
Provider Name | Dr. Mark A Celio |
First Address | Riverside, RI 02915-1420 |
Second Address | Providence, RI 02903-2905 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/02/2019 |
Last Update Date | 13/02/2019 |