Provider Demographics
NPI:1235308545
Name:ADELLE BURNSED-GEFFEN, PH.D.
Entity Type:Organization
Organization Name:ADELLE BURNSED-GEFFEN, PH.D.
Other - Org Name:PSYCHOLOGICAL RESOURCE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ADELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:BURNSED-GEFFEN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:912-354-7250
Mailing Address - Street 1:7203 HODGSON MEMORIAL DR
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31406-1504
Mailing Address - Country:US
Mailing Address - Phone:912-354-7250
Mailing Address - Fax:
Practice Address - Street 1:7203 HODGSON MEMORIAL DR
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31406-1504
Practice Address - Country:US
Practice Address - Phone:912-354-7250
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-21
Last Update Date:2008-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0958103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA300023708AMedicaid
GA300023708AMedicaid