Healthcare Provider Details

I. General information

NPI: 1285988386
Provider Name (Legal Business Name): OLENA A GELLER PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/29/2012
Last Update Date: 01/03/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1111 MARKET ST 2ND FLOOR
SAN FRANCISCO CA
94103-1509
US

IV. Provider business mailing address

1111 MARKET ST 2ND FLOOR
SAN FRANCISCO CA
94103-1509
US

V. Phone/Fax

Practice location:
  • Phone: 415-694-9477
  • Fax:
Mailing address:
  • Phone: 415-694-9477
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY 21467
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: