Healthcare Provider Details

I. General information

NPI: 1023155306
Provider Name (Legal Business Name): GESTALT INSTITUTE OF NEW ENGLAND INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/30/2007
Last Update Date: 10/24/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

240 A ELM ST. JOURNEY WOMEN
SOMERVILLE MA
02144
US

IV. Provider business mailing address

80 WINSLOW AVENUE UNIT 2E
SOMERVILLE MA
02144-2556
US

V. Phone/Fax

Practice location:
  • Phone: 617-764-2009
  • Fax:
Mailing address:
  • Phone: 617-764-2009
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name: MR. LEE GELTMAN
Title or Position: PRESIDENT
Credential: MA IN CLINICAL PSYCH
Phone: 617-764-2009