Healthcare Provider Details

I. General information

NPI: 1710057617
Provider Name (Legal Business Name): PATRICIA ALISON GELLER ED.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/08/2006
Last Update Date: 12/05/2025
Certification Date: 12/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

43 MOUNT AUBURN ST
WATERTOWN MA
02472-3924
US

IV. Provider business mailing address

19 S IRVING PARK
WATERTOWN MA
02472-2701
US

V. Phone/Fax

Practice location:
  • Phone: 617-319-6580
  • Fax:
Mailing address:
  • Phone: 617-926-0607
  • Fax: 617-926-0425

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number6463
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: