Healthcare Provider Details

I. General information

NPI: 1144410861
Provider Name (Legal Business Name): ETHELL ANN GELLER PH.D
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/30/2007
Last Update Date: 07/30/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

952 5TH AVE SUITE 1B
NEW YORK NY
10075-1740
US

IV. Provider business mailing address

952 5TH AVE SUITE 1B
NEW YORK NY
10075-1740
US

V. Phone/Fax

Practice location:
  • Phone: 212-861-7521
  • Fax:
Mailing address:
  • Phone: 212-861-7521
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number006173-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: