Healthcare Provider Details

I. General information

NPI: 1891849345
Provider Name (Legal Business Name): LEE GELTMAN MA IN CLINICAL PSYCH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/22/2007
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 Number623
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: