Healthcare Provider Details

I. General information

NPI: 1477904761
Provider Name (Legal Business Name): MARCIA GELLER PH.D
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/28/2016
Last Update Date: 06/28/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

223 RED FOX RD
STAMFORD CT
06903-4619
US

IV. Provider business mailing address

223 RED FOX RD
STAMFORD CT
06903-4619
US

V. Phone/Fax

Practice location:
  • Phone: 203-968-0229
  • Fax:
Mailing address:
  • Phone: 203-968-0229
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number000204
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: