Provider Demographics
NPI:1588691109
Name:MATTINGLY, CELESTE E (LCSW)
Entity type:Individual
Prefix:MS
First Name:CELESTE
Middle Name:E
Last Name:MATTINGLY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:10 GRASSMERE AVE
Mailing Address - Street 2:SUITE 300
Mailing Address - City:WEST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06110-1215
Mailing Address - Country:US
Mailing Address - Phone:860-586-8700
Mailing Address - Fax:860-236-1909
Practice Address - Street 1:10 GRASSMERE AVE
Practice Address - Street 2:SUITE 300
Practice Address - City:WEST HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06110-1215
Practice Address - Country:US
Practice Address - Phone:860-586-8700
Practice Address - Fax:860-236-1909
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-27
Last Update Date:2017-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0041901041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT211840OtherMENTAL HEALTH NETWORK/ HE
CTANTHEM BC/BSOther140004190CT04
CT62-30602OtherUNITED BEHAVIORAL HEALTH
CTP2654477OtherOXFORD
CT11-3646032OtherTAX ID
CT2036651OtherCIGNA BEHAVIORAL HEALTH
CT161565OtherVALUE OPTIONS
CT11-3646032OtherTAX ID