MEDICARE: GERALYN MCNAMARA M.A., LMFT

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	106H00000X	Marriage & Family Therapist	001361	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	001361	OTHER	GA	GA LICENSED MARRIAGE AND FAMILY THERAPIST NUMBER 001361

General Provider Information

NPI Number	:	1528377033
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GERALYN MCNAMARA M.A., LMFT

Provider Business Mailing Address
First Line	:	280 BLUE MOON XING
Second Line	:	APT 434
City	:	POOLER
State	:	GA
Zip	:	31322-9704
Country	:	US
Telephone Number	:	206-437-1549
Fax Number	:

Provider Business Practice Location Address
First Line	:	2591 US HIGHWAY 17
Second Line	:	SUITE 304
City	:	RICHMOND HILL
State	:	GA
Zip	:	31324-3864
Country	:	US
Telephone Number	:	206-437-1549
Fax Number	:

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

Provider Enumeration Date	:	09/30/2010
Last Update Date	:	02/03/2015

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