Individual
JACOB GELLES
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PSYD
Contact information
Practice address
811 FOSTER AVE, BROOKLYN, NY 11230-1358
(917) 225-0383
Mailing address
257 SOUTH ST, BIDDEFORD, ME 04005-2154
(917) 225-0383
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
015618
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
015618
LICENSE
NY
01
—
PS1511
MAINE PSYCHOLOGIST LICENSE
ME
Enumeration date
12/11/2006
Last updated
10/16/2024
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