Provider Demographics
NPI:1891194106
Name:CAROL EGER GELLER AND ASSOCIATES, LLC
Entity Type:Organization
Organization Name:CAROL EGER GELLER AND ASSOCIATES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BCBA
Authorized Official - Prefix:MS
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:EGER
Authorized Official - Last Name:GELLER
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:954-236-4631
Mailing Address - Street 1:10081 NW 3RD CT
Mailing Address - Street 2:
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33324-7049
Mailing Address - Country:US
Mailing Address - Phone:954-236-4631
Mailing Address - Fax:954-320-7873
Practice Address - Street 1:10081 NW 3RD CT
Practice Address - Street 2:
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33324-7049
Practice Address - Country:US
Practice Address - Phone:954-236-4631
Practice Address - Fax:954-320-7873
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-22
Last Update Date:2014-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL000861200Medicaid