Healthcare Provider Details

I. General information

NPI: 1407127699
Provider Name (Legal Business Name): KAREN FERN GELLER LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/19/2012
Last Update Date: 01/19/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1948 NE 123RD ST SUITE 107
NORTH MIAMI FL
33181-2800
US

IV. Provider business mailing address

1271 94TH ST
BAY HARBOR ISLANDS FL
33154-1901
US

V. Phone/Fax

Practice location:
  • Phone: 305-609-3433
  • Fax:
Mailing address:
  • Phone: 305-609-3433
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSW 4613
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: