Provider Demographics
NPI:1366631855
Name:GELLER, MARVIN H (MARVIN GELLER)
Entity Type:Individual
Prefix:DR
First Name:MARVIN
Middle Name:H
Last Name:GELLER
Suffix:
Gender:M
Credentials:MARVIN GELLER
Other - Prefix:DR
Other - First Name:MARVIN
Other - Middle Name:H
Other - Last Name:GELLER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:11 CHARLTON ST
Mailing Address - Street 2:
Mailing Address - City:PRINCETON
Mailing Address - State:NJ
Mailing Address - Zip Code:08540-5231
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:11 CHARLTON ST
Practice Address - Street 2:
Practice Address - City:PRINCETON
Practice Address - State:NJ
Practice Address - Zip Code:08540-5231
Practice Address - Country:US
Practice Address - Phone:609-924-0257
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-19
Last Update Date:2009-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ813102L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes102L00000XBehavioral Health & Social Service ProvidersPsychoanalyst