Provider Demographics
NPI:1790823003
Name:GELLER, CAROL (MA, CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:CAROL
Middle Name:
Last Name:GELLER
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:298 MEDEA WAY
Mailing Address - Street 2:
Mailing Address - City:CENTRAL ISLIP
Mailing Address - State:NY
Mailing Address - Zip Code:11722-4540
Mailing Address - Country:US
Mailing Address - Phone:631-757-4289
Mailing Address - Fax:631-757-6313
Practice Address - Street 1:298 MEDEA WAY
Practice Address - Street 2:
Practice Address - City:CENTRAL ISLIP
Practice Address - State:NY
Practice Address - Zip Code:11722-4540
Practice Address - Country:US
Practice Address - Phone:631-757-4289
Practice Address - Fax:631-757-6313
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-01
Last Update Date:2019-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003165-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist