Provider Demographics
NPI:1538905328
Name:GESELMAN, MARIA ANN (LSW)
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:ANN
Last Name:GESELMAN
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1420 RENAISSANCE DR APT A305
Mailing Address - Street 2:
Mailing Address - City:LONGMONT
Mailing Address - State:CO
Mailing Address - Zip Code:80503-6967
Mailing Address - Country:US
Mailing Address - Phone:989-763-6013
Mailing Address - Fax:
Practice Address - Street 1:221 E 29TH ST STE 201
Practice Address - Street 2:
Practice Address - City:LOVELAND
Practice Address - State:CO
Practice Address - Zip Code:80538-2746
Practice Address - Country:US
Practice Address - Phone:989-763-6013
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-02
Last Update Date:2024-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0009925423104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker