Healthcare Provider Details

I. General information

NPI: 1134293079
Provider Name (Legal Business Name): JANET A GELLER LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

65 W 95TH ST APT 6D
NEW YORK NY
10025-6795
US

IV. Provider business mailing address

65 W 95TH ST APT 6D
NEW YORK NY
10025-6795
US

V. Phone/Fax

Practice location:
  • Phone: 212-866-1003
  • Fax: 212-866-1003
Mailing address:
  • Phone: 212-866-1003
  • Fax: 212-866-1003

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberR011206
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: