Provider Demographics
NPI:1316256910
Name:DEGLOMA, CELENA (MS LMT CD CLC CCCE)
Entity type:Individual
Prefix:
First Name:CELENA
Middle Name:
Last Name:DEGLOMA
Suffix:
Gender:F
Credentials:MS LMT CD CLC CCCE
Other - Prefix:
Other - First Name:LENA
Other - Middle Name:
Other - Last Name:DEGLOMA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MS LMT CD CLC CCCE
Mailing Address - Street 1:405 5TH AVE FL 2
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11215-3315
Mailing Address - Country:US
Mailing Address - Phone:347-699-8751
Mailing Address - Fax:
Practice Address - Street 1:405 5TH AVE FL 2
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11215-3315
Practice Address - Country:US
Practice Address - Phone:347-699-8751
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-29
Last Update Date:2021-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
133NN1002X, 374J00000X
NY43673174N00000X
NY021538-01225700000X
NY021538172M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes172M00000XOther Service ProvidersMechanotherapist
No133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education
No174N00000XOther Service ProvidersLactation Consultant, Non-RNGroup - Multi-Specialty
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty
No374J00000XNursing Service Related ProvidersDoula