Provider Demographics
NPI:1235354234
Name:GELLER, PETER (LCSW)
Entity Type:Individual
Prefix:MR
First Name:PETER
Middle Name:
Last Name:GELLER
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1607 ROUTE 300
Mailing Address - Street 2:STE 101
Mailing Address - City:NEWBURGH
Mailing Address - State:NY
Mailing Address - Zip Code:12550-1738
Mailing Address - Country:US
Mailing Address - Phone:845-567-6027
Mailing Address - Fax:845-567-6527
Practice Address - Street 1:1607 ROUTE 300
Practice Address - Street 2:STE 101
Practice Address - City:NEWBURGH
Practice Address - State:NY
Practice Address - Zip Code:12550-1738
Practice Address - Country:US
Practice Address - Phone:845-567-6027
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-16
Last Update Date:2020-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR029522-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY139050OtherVALUEOPTIONS PROVIDER ID
MOMIS 207563000OtherMAGELLAN INS. PROVIDER ID
NY7481780OtherGHI INS. CO. PROVIDER ID