Provider Demographics
NPI:1477723898
Name:GELLER, ELLIOT M (LCSW)
Entity Type:Individual
Prefix:MR
First Name:ELLIOT
Middle Name:M
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 1:811 NW 20TH AVE
Mailing Address - Street 2:SUITE 302
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97209-1443
Mailing Address - Country:US
Mailing Address - Phone:503-224-1433
Mailing Address - Fax:
Practice Address - Street 1:811 NW 20TH AVE
Practice Address - Street 2:SUITE 302
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97209-1443
Practice Address - Country:US
Practice Address - Phone:503-224-1433
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-03
Last Update Date:2008-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR07091041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical