Healthcare Provider Details

I. General information

NPI: 1477610376
Provider Name (Legal Business Name): DENISE JEANNE GELINAS PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/02/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

277 MAIN ST RM 203
NORTHAMPTON MA
01060-3171
US

IV. Provider business mailing address

125 PROSPECT ST
NORTHAMPTON MA
01060-2165
US

V. Phone/Fax

Practice location:
  • Phone: 413-584-2617
  • Fax: 413-584-4923
Mailing address:
  • Phone: 413-586-4225
  • Fax: 413-584-4923

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number2279
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: