Provider Demographics
NPI:1467576116
Name:GELERNTER, CHERYL SHEA (PHD)
Entity Type:Individual
Prefix:DR
First Name:CHERYL
Middle Name:SHEA
Last Name:GELERNTER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 BRADLEY RD
Mailing Address - Street 2:SUITE 903
Mailing Address - City:WOODBRIDGE
Mailing Address - State:CT
Mailing Address - Zip Code:06525-2285
Mailing Address - Country:US
Mailing Address - Phone:203-397-0653
Mailing Address - Fax:
Practice Address - Street 1:1 BRADLEY RD
Practice Address - Street 2:SUITE 903
Practice Address - City:WOODBRIDGE
Practice Address - State:CT
Practice Address - Zip Code:06525-2285
Practice Address - Country:US
Practice Address - Phone:203-397-0653
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001660103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT060001660CT02OtherANTHEM PROVIDER NUMBER
CT060001660CT02OtherANTHEM PROVIDER NUMBER