Healthcare Provider Details

I. General information

NPI: 1477699809
Provider Name (Legal Business Name): CHARLES GELLER LCSW, DCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/30/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

341 N MAITLAND AVE SUITE 160
MAITLAND FL
32751-4783
US

IV. Provider business mailing address

431 FALLS CT
ALTAMONTE SPRINGS FL
32714-7508
US

V. Phone/Fax

Practice location:
  • Phone: 407-923-9181
  • Fax: 407-834-5800
Mailing address:
  • Phone: 407-923-9181
  • Fax: 407-834-5800

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSW7199
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: