Provider Demographics
NPI:1477699809
Name:GELLER, CHARLES (LCSW, DCSW)
Entity Type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:
Last Name:GELLER
Suffix:
Gender:M
Credentials:LCSW, DCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:431 FALLS CT
Mailing Address - Street 2:
Mailing Address - City:ALTAMONTE SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32714-7508
Mailing Address - Country:US
Mailing Address - Phone:407-923-9181
Mailing Address - Fax:407-834-5800
Practice Address - Street 1:341 N MAITLAND AVE
Practice Address - Street 2:SUITE 160
Practice Address - City:MAITLAND
Practice Address - State:FL
Practice Address - Zip Code:32751-4783
Practice Address - Country:US
Practice Address - Phone:407-923-9181
Practice Address - Fax:407-834-5800
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW71991041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical