Individual
MS. CELESTE E MATTINGLY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
004190
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
11-3646032
TAX ID
CT
01
—
161565
VALUE OPTIONS
CT
01
—
2036651
CIGNA BEHAVIORAL HEALTH
CT
01
—
211840
MENTAL HEALTH NETWORK/ HE
CT
01
—
62-30602
UNITED BEHAVIORAL HEALTH
CT
01
—
ANTHEM BC/BS
140004190CT04
CT
01
—
P2654477
OXFORD
CT
Enumeration date
06/27/2006
Last updated
01/27/2017
Update your record
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