Healthcare Provider Details

I. General information

NPI: 1578702155
Provider Name (Legal Business Name): MICHAEL JOHN GELLERT M.A., M.S.W.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/05/2009
Last Update Date: 02/05/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3846 MCLAUGHLIN AVE
LOS ANGELES CA
90066-4010
US

IV. Provider business mailing address

3846 MCLAUGHLIN AVE
LOS ANGELES CA
90066-4010
US

V. Phone/Fax

Practice location:
  • Phone: 310-313-3063
  • Fax: 310-313-3063
Mailing address:
  • Phone: 310-313-3063
  • Fax: 310-313-3063

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCS16153
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: