Provider Demographics
NPI:1023155306
Name:GESTALT INSTITUTE OF NEW ENGLAND INC
Entity type:Organization
Organization Name:GESTALT INSTITUTE OF NEW ENGLAND INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:LEE
Authorized Official - Middle Name:
Authorized Official - Last Name:GELTMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MA IN CLINICAL PSYCH
Authorized Official - Phone:617-764-2009
Mailing Address - Street 1:80 WINSLOW AVENUE
Mailing Address - Street 2:UNIT 2E
Mailing Address - City:SOMERVILLE
Mailing Address - State:MA
Mailing Address - Zip Code:02144-2556
Mailing Address - Country:US
Mailing Address - Phone:617-764-2009
Mailing Address - Fax:
Practice Address - Street 1:240 A ELM ST.
Practice Address - Street 2:JOURNEY WOMEN
Practice Address - City:SOMERVILLE
Practice Address - State:MA
Practice Address - Zip Code:02144
Practice Address - Country:US
Practice Address - Phone:617-764-2009
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-30
Last Update Date:2008-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAGEW10063OtherBLUE CROSS BLUE SHIELD
MA717059OtherTUFTS HEALTH PLAN MEDICAR
MAGEW10063OtherBLUE CROSS BLUE SHIELD