Provider Demographics
NPI:1740463389
Name:FANELLI, GERI M (LMHC, MA COMMUNITY &)
Entity type:Individual
Prefix:MS
First Name:GERI
Middle Name:M
Last Name:FANELLI
Suffix:
Gender:F
Credentials:LMHC, MA COMMUNITY &
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 HURLEY AVE STE 203
Mailing Address - Street 2:
Mailing Address - City:KINGSTON
Mailing Address - State:NY
Mailing Address - Zip Code:12401-2800
Mailing Address - Country:US
Mailing Address - Phone:845-489-8874
Mailing Address - Fax:845-217-5693
Practice Address - Street 1:101 HURLEY AVE STE 203
Practice Address - Street 2:
Practice Address - City:KINGSTON
Practice Address - State:NY
Practice Address - Zip Code:12401-2800
Practice Address - Country:US
Practice Address - Phone:845-489-8874
Practice Address - Fax:845-217-5693
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-05
Last Update Date:2017-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000519101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health