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NPI Code Detail

MEDICARE: MR. MICHAEL JOHN GELLERT M.A., M.S.W.

MEDICARE: MR. MICHAEL JOHN GELLERT M.A., M.S.W.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11041C0700XClinical Social WorkerLCS16153CA

General Provider Information

NPI Number : 1578702155
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. MICHAEL JOHN GELLERT M.A., M.S.W.
Provider Business Mailing Address
First Line : 3846 MCLAUGHLIN AVE
Second Line :
City : LOS ANGELES
State : CA
Zip : 90066-4010
Country : US
Telephone Number : 310-313-3063
Fax Number : 310-313-3063
Provider Business Practice Location Address
First Line : 3846 MCLAUGHLIN AVE
Second Line :
City : LOS ANGELES
State : CA
Zip : 90066-4010
Country : US
Telephone Number : 310-313-3063
Fax Number : 310-313-3063
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/05/2009
Last Update Date : 02/05/2009

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