Healthcare Provider Details

I. General information

NPI: 1184633422
Provider Name (Legal Business Name): JANE CARLA GELLERT PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/05/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 PINNACLE PL #207
ALBANY NY
12203-3496
US

IV. Provider business mailing address

11 KINGS CT
CLIFTON PARK NY
12065-5291
US

V. Phone/Fax

Practice location:
  • Phone: 518-258-3270
  • Fax:
Mailing address:
  • Phone: 518-383-6512
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number010468-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: