Healthcare Provider Details

I. General information

NPI: 1235354234
Provider Name (Legal Business Name): PETER GELLER LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/16/2007
Last Update Date: 02/27/2020
Certification Date: 02/27/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1607 ROUTE 300 STE 101
NEWBURGH NY
12550-1738
US

IV. Provider business mailing address

1607 ROUTE 300 STE 101
NEWBURGH NY
12550-1738
US

V. Phone/Fax

Practice location:
  • Phone: 845-567-6027
  • Fax:
Mailing address:
  • Phone: 845-567-6027
  • Fax: 845-567-6527

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberR029522-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: