Healthcare Provider Details

I. General information

NPI: 1437520236
Provider Name (Legal Business Name): MIMI GELB LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/19/2015
Last Update Date: 10/19/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 SQUADRON BLVD
NEW CITY NY
10956-5200
US

IV. Provider business mailing address

7 WHEATSTONE RD
NEW CITY NY
10956-2515
US

V. Phone/Fax

Practice location:
  • Phone: 845-548-8838
  • Fax: 845-639-9473
Mailing address:
  • Phone: 845-548-8838
  • Fax: 845-639-9473

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number001209-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: