Provider Demographics
NPI:1841574290
Name:GEIST, AUDREY
Entity Type:Individual
Prefix:DR
First Name:AUDREY
Middle Name:
Last Name:GEIST
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:527 WEST 143RD STREET APARTMENT 22
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10031-6036
Mailing Address - Country:US
Mailing Address - Phone:718-619-2324
Mailing Address - Fax:
Practice Address - Street 1:527 W 143RD ST APT 22
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10031-6036
Practice Address - Country:US
Practice Address - Phone:718-619-2324
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-04
Last Update Date:2011-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD026208E101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health