Provider Demographics
NPI:1447539911
Name:QUIROGA, CELESTINE MARIE (MS)
Entity type:Individual
Prefix:
First Name:CELESTINE
Middle Name:MARIE
Last Name:QUIROGA
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1035 S STATE ROAD 7 STE 315
Mailing Address - Street 2:
Mailing Address - City:WELLINGTON
Mailing Address - State:FL
Mailing Address - Zip Code:33414-6137
Mailing Address - Country:US
Mailing Address - Phone:561-571-5501
Mailing Address - Fax:
Practice Address - Street 1:1035 S STATE ROAD 7 STE 315
Practice Address - Street 2:
Practice Address - City:WELLINGTON
Practice Address - State:FL
Practice Address - Zip Code:33414-6137
Practice Address - Country:US
Practice Address - Phone:561-571-5501
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-15
Last Update Date:2019-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH12300101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL014645000Medicaid