Healthcare Provider Details

I. General information

NPI: 1134302474
Provider Name (Legal Business Name): JAMIE ROSE GELLER PSY.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/10/2007
Last Update Date: 02/08/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9199 REISTERSTOWN RD 204 B
OWINGS MILLS MD
21117-4520
US

IV. Provider business mailing address

9199 REISTERSTOWN RD 204 B
OWINGS MILLS MD
21117-4520
US

V. Phone/Fax

Practice location:
  • Phone: 443-310-4460
  • Fax:
Mailing address:
  • Phone: 443-310-4460
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number04896
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: