Provider Demographics
NPI:1417581208
Name:GELLER, JILL LEWENBERG (LCAT)
Entity type:Individual
Prefix:MRS
First Name:JILL
Middle Name:LEWENBERG
Last Name:GELLER
Suffix:
Gender:F
Credentials:LCAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:209 E 23RD ST RM 105
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10010-3901
Mailing Address - Country:US
Mailing Address - Phone:212-592-2178
Mailing Address - Fax:
Practice Address - Street 1:209 E 23RD ST RM 105
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10010-3901
Practice Address - Country:US
Practice Address - Phone:917-304-7484
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-02
Last Update Date:2020-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001139-1221700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes221700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersArt TherapistGroup - Single Specialty