Healthcare Provider Details

I. General information

NPI: 1467490409
Provider Name (Legal Business Name): ISAAC S GELLEY LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: ISSAC GELLEY LCSW

II. Dates (important events)

Enumeration Date: 06/03/2006
Last Update Date: 08/29/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

681 RIVER AVE
LAKEWOOD NJ
08701
US

IV. Provider business mailing address

101 SUMMIT LN APT M-0
BALA CYNWYD PA
19004-2933
US

V. Phone/Fax

Practice location:
  • Phone: 732-901-0035
  • Fax:
Mailing address:
  • Phone: 732-616-2266
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number44SC05286200
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: