Healthcare Provider Details

I. General information

NPI: 1336417112
Provider Name (Legal Business Name): MARIAN J GELLER LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/07/2011
Last Update Date: 12/07/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22 LINCOLN AVE
NORTHAMPTON MA
01060-2331
US

IV. Provider business mailing address

22 LINCOLN AVE
NORTHAMPTON MA
01060-2331
US

V. Phone/Fax

Practice location:
  • Phone: 413-896-6240
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number111185
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: