MEDICARE: MS. GERALDINE PANZERA MA, LPC, NCC

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	101YM0800X	Mental Health Counselor	37PC00322200	NJ
2	101YM0800X	Mental Health Counselor
3	101Y00000X	Counselor	37PC00322200	NJ
4	101YM0800X	Mental Health Counselor	PC003618	PA

General Provider Information

NPI Number	:	1669520870
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. GERALDINE PANZERA MA, LPC, NCC

Provider Business Mailing Address
First Line	:	PO BOX 375
Second Line	:
City	:	BEVERLY
State	:	NJ
Zip	:	08010-0375
Country	:	US
Telephone Number	:	609-351-9125
Fax Number	:	856-389-5454

Provider Business Practice Location Address
First Line	:	2 COTTAGE AVE
Second Line	:
City	:	EDGEWATER PARK
State	:	NJ
Zip	:	08010-1411
Country	:	US
Telephone Number	:	609-351-9125
Fax Number	:	346-636-4479

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

Provider Enumeration Date	:	01/08/2007
Last Update Date	:	08/10/2023

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