Jeannie E. Celestial, PHD

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

29740 Issued in CA

Practice address

1761 Broadway St Ste 100
Vallejo, CA 94589-2227

Phone

(707) 645-2700

NPI assigned

May 30, 2007

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1180483200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1523491200000",
    "number": "1568663219",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1727 MARTIN LUTHER KING JR WAY",
            "address_2": "SUITE 19",
            "city": "OAKLAND",
            "state": "CA",
            "postal_code": "946121358",
            "telephone_number": "510-893-9230",
            "fax_number": "510-893-2074"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1761 BROADWAY ST STE 100",
            "city": "VALLEJO",
            "state": "CA",
            "postal_code": "945892227",
            "telephone_number": "707-645-2700"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1727 Martin Luther King Jr Way",
            "address_2": "Suite 19",
            "address_purpose": "LOCATION",
            "city": "Oakland",
            "state": "CA",
            "postal_code": "946121358",
            "country_code": "US",
            "telephone_number": "510-893-9230",
            "fax_number": "510-893-2074",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CELESTIAL",
        "first_name": "JEANNIE",
        "middle_name": "E.",
        "name_prefix": "Dr.",
        "credential": "PHD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-05-30",
        "last_updated": "2018-04-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "CA",
            "license": "ASW 15425",
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "CA",
            "license": "29740",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Clinical Psychologist in Vallejo, CA
• Providers in Vallejo, CA by specialty
• Clinical Psychologist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 12, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.