Provider Demographics
NPI:1891849345
Name:GELTMAN, LEE (MA IN CLINICAL PSYCH)
Entity Type:Individual
Prefix:MR
First Name:LEE
Middle Name:
Last Name:GELTMAN
Suffix:
Gender:M
Credentials:MA IN CLINICAL PSYCH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:80 WINSLOW AVENUE
Mailing Address - Street 2:UNIT 2E
Mailing Address - City:SOMERVILLE
Mailing Address - State:MA
Mailing Address - Zip Code:02144-2556
Mailing Address - Country:US
Mailing Address - Phone:617-764-2009
Mailing Address - Fax:
Practice Address - Street 1:240 A ELM ST.
Practice Address - Street 2:JOURNEY WOMEN
Practice Address - City:SOMERVILLE
Practice Address - State:MA
Practice Address - Zip Code:02144
Practice Address - Country:US
Practice Address - Phone:617-764-2009
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-22
Last Update Date:2008-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA623103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAGEW01122OtherBLUE CROSS BLUE SHIELD
MAGEW01122OtherBLUE CROSS BLUE SHIELD