Provider Demographics
NPI:1881276715
Name:GELLER, ANGEL MARY LORETTA LIEB (CPSS)
Entity type:Individual
Prefix:MRS
First Name:ANGEL
Middle Name:MARY LORETTA LIEB
Last Name:GELLER
Suffix:
Gender:F
Credentials:CPSS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2830 S 72ND ST APT 111
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68506-3669
Mailing Address - Country:US
Mailing Address - Phone:531-739-8758
Mailing Address - Fax:
Practice Address - Street 1:2641 S 70TH ST STE A
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68506-2912
Practice Address - Country:US
Practice Address - Phone:402-327-9711
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-21
Last Update Date:2021-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NECPSS-088175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist