Provider Demographics
NPI:1740482728
Name:GELLER, HANNAH L (PHD)
Entity type:Individual
Prefix:DR
First Name:HANNAH
Middle Name:L
Last Name:GELLER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:HANNAH
Other - Middle Name:
Other - Last Name:LATYSHEV
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHD
Mailing Address - Street 1:19 W 34TH ST
Mailing Address - Street 2:PH FLOOR
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10001-3006
Mailing Address - Country:US
Mailing Address - Phone:646-479-4660
Mailing Address - Fax:646-871-0150
Practice Address - Street 1:19 W 34TH ST
Practice Address - Street 2:PH FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10001-3006
Practice Address - Country:US
Practice Address - Phone:646-479-4660
Practice Address - Fax:646-871-0150
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-03
Last Update Date:2016-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY019478103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY12419556OtherCAQH