Healthcare Provider Details

I. General information

NPI: 1780615435
Provider Name (Legal Business Name): DEBORAH GELLIS LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/05/2006
Last Update Date: 06/26/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1825 FOREST HILL BLVD STE 103
WEST PALM BEACH FL
33406
US

IV. Provider business mailing address

PO BOX 223211
WEST PALM BEACH FL
33422-3211
US

V. Phone/Fax

Practice location:
  • Phone: 917-838-3384
  • Fax:
Mailing address:
  • Phone: 917-838-3384
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSW12767
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number071000-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: