Provider Demographics
NPI:1265594667
Name:GELLER, MAUREEN (LCSW)
Entity type:Individual
Prefix:
First Name:MAUREEN
Middle Name:
Last Name:GELLER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:630 UNION ST
Mailing Address - Street 2:#3D
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11215-1116
Mailing Address - Country:US
Mailing Address - Phone:718-398-7481
Mailing Address - Fax:718-857-5055
Practice Address - Street 1:630 UNION ST
Practice Address - Street 2:#3D
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11215-1116
Practice Address - Country:US
Practice Address - Phone:718-398-7481
Practice Address - Fax:718-857-5055
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-14
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR047179-01104100000X
NYR047179-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered104100000XBehavioral Health & Social Service ProvidersSocial Worker
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01526461Medicaid
NYON5M23Medicare ID - Type UnspecifiedMEDICARE NUMBER