MEDICARE: MS. MICHELLE ALYSSA GEFFEN M.A.

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

General Provider Information

NPI Number	:	1952753048
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MICHELLE ALYSSA GEFFEN M.A.

Provider Business Mailing Address
First Line	:	500 FALLS BLVD
Second Line	:	APARTMENT 2332
City	:	QUINCY
State	:	MA
Zip	:	02169-8178
Country	:	US
Telephone Number	:	516-987-7326
Fax Number	:

Provider Business Practice Location Address
First Line	:	500 FALLS BLVD
Second Line	:	APARTMENT 2332
City	:	QUINCY
State	:	MA
Zip	:	02169-8178
Country	:	US
Telephone Number	:	516-987-7326
Fax Number	:

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

Provider Enumeration Date	:	07/13/2016
Last Update Date	:	07/13/2016

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