Provider Demographics
NPI:1447878947
Name:MANTOVANI, CELIA (LCPC)
Entity type:Individual
Prefix:
First Name:CELIA
Middle Name:
Last Name:MANTOVANI
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:77 BLANCHARD RD
Mailing Address - Street 2:
Mailing Address - City:CUMBERLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04021-3500
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:207-331-7695
Practice Address - Street 1:77 BLANCHARD RD
Practice Address - Street 2:
Practice Address - City:CUMBERLAND
Practice Address - State:ME
Practice Address - Zip Code:04021-3500
Practice Address - Country:US
Practice Address - Phone:207-331-7695
Practice Address - Fax:207-331-7695
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-10
Last Update Date:2024-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECC5637101YP2500X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
14919161OtherCAHQ
MI4301502838OtherMD LICENSE