Healthcare Provider Details

I. General information

NPI: 1528709094
Provider Name (Legal Business Name): CARLY GELLER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/06/2022
Last Update Date: 09/07/2024
Certification Date: 09/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

185 E 85TH ST
NEW YORK NY
10028-2140
US

IV. Provider business mailing address

1280 LEXINGTON AVE FRNT 2
NEW YORK NY
10028-2136
US

V. Phone/Fax

Practice location:
  • Phone: 917-512-3812
  • Fax:
Mailing address:
  • Phone: 917-512-3812
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number024886
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: