| Doctor Name: | DR. MICHAEL CELESTINO JORGE |
| NPI Number: | 1033531090 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | PHD |
| License Number: | 5170 |
| Business Practice Address: | 8180 Brecksville Rd Ste 115 Brecksville, OH - 441411374 |
| Business Phone Number: | 4405460048 |
| Business Fax Number: | 8888282326 |
| Mailing Address: | 13500 Pearl Rd, Suite139 #177, STRONGSVILLE |
| State: | OH |
| Postal Code: | 44136 |
| Phone Number: | 8134409972 |
| Fax Number: | |
| NPI Enumeration Date: | 01/10/2014 |
| NPI Last Update Date: | 01/10/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 103TC1900X |
| License Number: | 5170 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | OH |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Psychologist |
| Taxonomy Specialization: | Counseling |
| Taxonomy Definition: | |