Provider Demographics
NPI:1316760309
Name:CELESTIN, MISCHAEL PIERRE
Entity type:Individual
Prefix:
First Name:MISCHAEL
Middle Name:PIERRE
Last Name:CELESTIN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:357 ASH ST
Mailing Address - Street 2:
Mailing Address - City:BROCKTON
Mailing Address - State:MA
Mailing Address - Zip Code:02301-5004
Mailing Address - Country:US
Mailing Address - Phone:774-433-3591
Mailing Address - Fax:
Practice Address - Street 1:357 ASH ST
Practice Address - Street 2:
Practice Address - City:BROCKTON
Practice Address - State:MA
Practice Address - Zip Code:02301-5004
Practice Address - Country:US
Practice Address - Phone:774-433-3591
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-06
Last Update Date:2024-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician