Provider Demographics
NPI:1710057617
Name:GELLER, PATRICIA ALISON (EDD)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:ALISON
Last Name:GELLER
Suffix:
Gender:F
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 IRVING PARK
Mailing Address - Street 2:
Mailing Address - City:WATERTOWN
Mailing Address - State:MA
Mailing Address - Zip Code:02472-2701
Mailing Address - Country:US
Mailing Address - Phone:617-926-0607
Mailing Address - Fax:617-926-0425
Practice Address - Street 1:SUITE 25
Practice Address - Street 2:76 BEDFORD STREET
Practice Address - City:LEXINGTON
Practice Address - State:MA
Practice Address - Zip Code:02420
Practice Address - Country:US
Practice Address - Phone:781-863-2434
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA6463103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical