Provider Demographics
NPI:1497943450
Name:GELLER, RUTH (LCSW)
Entity Type:Individual
Prefix:
First Name:RUTH
Middle Name:
Last Name:GELLER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:389 WHITNEY AVE
Mailing Address - Street 2:
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06511-2301
Mailing Address - Country:US
Mailing Address - Phone:203-865-1638
Mailing Address - Fax:203-230-8502
Practice Address - Street 1:389 WHITNEY AVE
Practice Address - Street 2:
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06511-2301
Practice Address - Country:US
Practice Address - Phone:203-865-1638
Practice Address - Fax:203-230-8502
Is Sole Proprietor?:No
Enumeration Date:2007-10-04
Last Update Date:2007-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT00015741041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT0001574OtherSTATE LICENSE NUMBER