Healthcare Provider Details

I. General information

NPI: 1568519916
Provider Name (Legal Business Name): ANDREW LEE GELLER L.C.S.W.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/05/2007
Last Update Date: 02/18/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19 W 34TH ST PENTHOUSE A-3
NEW YORK NY
10001-3006
US

IV. Provider business mailing address

515 E 85TH ST APT. 6B
NEW YORK NY
10028-7421
US

V. Phone/Fax

Practice location:
  • Phone: 212-947-7111
  • Fax: 212-239-0948
Mailing address:
  • Phone: 917-806-7532
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberR040501-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: