Provider Demographics
NPI:1841288487
Name:GEISLER, CAROL (CP)
Entity type:Individual
Prefix:
First Name:CAROL
Middle Name:
Last Name:GEISLER
Suffix:
Gender:F
Credentials:CP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 SULLIVAN ST
Mailing Address - Street 2:APT 4A
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10012-3625
Mailing Address - Country:US
Mailing Address - Phone:212-966-0958
Mailing Address - Fax:
Practice Address - Street 1:230 W 13TH ST
Practice Address - Street 2:3
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10011-7700
Practice Address - Country:US
Practice Address - Phone:212-966-0958
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-07
Last Update Date:2008-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007571103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00971068Medicaid
NY60629866OtherUNITED BEHAVIORAL HEALTH
NY0057295OtherGHI
NYP593477OtherOXFORD HEALTH PLANS
NY072375OtherVALUE OPTIONS
NYV4A111Medicare UPIN