Healthcare Provider Details

I. General information

NPI: 1245474279
Provider Name (Legal Business Name): MARCIA GELLERT LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/21/2009
Last Update Date: 06/06/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

65 S MANOR DR
WHITE PLAINS NY
10603-1903
US

IV. Provider business mailing address

65 S MANOR DR
WHITE PLAINS NY
10603-1903
US

V. Phone/Fax

Practice location:
  • Phone: 914-358-5460
  • Fax: 914-358-5460
Mailing address:
  • Phone: 914-358-5460
  • Fax: 914-358-5460

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberP0165381
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License NumberP0165381
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: