Healthcare Provider Details

I. General information

NPI: 1104682392
Provider Name (Legal Business Name): ALLISON GELLER LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/26/2024
Last Update Date: 02/26/2024
Certification Date: 02/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

79 MIDDLEVILLE RD
NORTHPORT NY
11768-2200
US

IV. Provider business mailing address

39 DEWEY ST APT 2
HUNTINGTON NY
11743-7100
US

V. Phone/Fax

Practice location:
  • Phone: 631-261-4400
  • Fax:
Mailing address:
  • Phone: 631-833-0358
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number094463-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: