Healthcare Provider Details

I. General information

NPI: 1265715080
Provider Name (Legal Business Name): RORRI GELLER-MOHAMED LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/28/2011
Last Update Date: 02/19/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6143 186TH ST
FRESH MEADOWS NY
11365-2710
US

IV. Provider business mailing address

STONEHURST CIR
LAKE WORTH FL
33467-7368
US

V. Phone/Fax

Practice location:
  • Phone: 347-460-4308
  • Fax: 347-460-4308
Mailing address:
  • Phone: 347-460-4308
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSW12269
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: