Provider Demographics
NPI:1487684544
Name:GELERNTER, SPENCER H (PHD)
Entity Type:Individual
Prefix:DR
First Name:SPENCER
Middle Name:H
Last Name:GELERNTER
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3901 ROSWELL RD
Mailing Address - Street 2:STE 210
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30062-8809
Mailing Address - Country:US
Mailing Address - Phone:770-509-8266
Mailing Address - Fax:770-509-8966
Practice Address - Street 1:3901 ROSWELL RD
Practice Address - Street 2:STE 210
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30062-8809
Practice Address - Country:US
Practice Address - Phone:770-509-8266
Practice Address - Fax:770-509-8966
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA1303103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical