Provider Demographics
NPI:1124802020
Name:GELLER, MATT (LMSW)
Entity type:Individual
Prefix:
First Name:MATT
Middle Name:
Last Name:GELLER
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:MATITYAHU
Other - Middle Name:
Other - Last Name:GELLER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LMSW
Mailing Address - Street 1:64 OLD RIVERHEAD RD
Mailing Address - Street 2:
Mailing Address - City:WESTHAMPTON BEACH
Mailing Address - State:NY
Mailing Address - Zip Code:11978-1451
Mailing Address - Country:US
Mailing Address - Phone:631-606-2927
Mailing Address - Fax:
Practice Address - Street 1:64 OLD RIVERHEAD RD
Practice Address - Street 2:
Practice Address - City:WESTHAMPTON BEACH
Practice Address - State:NY
Practice Address - Zip Code:11978-1451
Practice Address - Country:US
Practice Address - Phone:631-606-2927
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-22
Last Update Date:2024-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY107347104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker