Healthcare Provider Details

I. General information

NPI: 1417581208
Provider Name (Legal Business Name): JILL LEWENBERG GELLER LCAT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/02/2020
Last Update Date: 03/02/2020
Certification Date: 03/02/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

209 E 23RD ST RM 105
NEW YORK NY
10010-3901
US

IV. Provider business mailing address

209 E 23RD ST RM 105
NEW YORK NY
10010-3901
US

V. Phone/Fax

Practice location:
  • Phone: 917-304-7484
  • Fax:
Mailing address:
  • Phone: 212-592-2178
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code221700000X
TaxonomyArt Therapist
License Number001139-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: