MEDICARE: DEBORAH GELLIS LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	SW12767	FL
2	1041C0700X	Clinical Social Worker	071000-1	NY

General Provider Information

NPI Number	:	1780615435
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DEBORAH GELLIS LCSW

Provider Business Mailing Address
First Line	:	PO BOX 223211
Second Line	:
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33422-3211
Country	:	US
Telephone Number	:	917-838-3384
Fax Number	:

Provider Business Practice Location Address
First Line	:	1825 FOREST HILL BLVD STE 103
Second Line	:
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33406
Country	:	US
Telephone Number	:	917-838-3384
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/05/2006
Last Update Date	:	06/26/2018

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