Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TC1900X | Counseling Psychologist | 5170 | OH |
NPI | 1033531090 |
---|---|
Provider Name | Dr. Michael Celestino Jorge |
First Address | Strongsville, OH 44136 |
Second Address | Brecksville, OH 44141-1374 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/01/2014 |
Last Update Date | 10/01/2014 |