MEDICARE: ANDREA GERAGHTY LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	30882	ID

General Provider Information

NPI Number	:	1043353022
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANDREA GERAGHTY LCSW

Provider Business Mailing Address
First Line	:	1006 N 28TH ST
Second Line	:
City	:	BOISE
State	:	ID
Zip	:	83702-2205
Country	:	US
Telephone Number	:	208-854-9950
Fax Number	:

Provider Business Practice Location Address
First Line	:	7337 W NORTHVIEW ST
Second Line	:
City	:	BOISE
State	:	ID
Zip	:	83704-7360
Country	:	US
Telephone Number	:	208-340-5894
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/15/2007
Last Update Date	:	05/16/2015

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