Healthcare Provider Details

I. General information

NPI: 1952735052
Provider Name (Legal Business Name): MS. JAMIE GEORGAKIS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/26/2013
Last Update Date: 08/26/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 OLD LYMAN RD
SOUTH HADLEY MA
01075-2630
US

IV. Provider business mailing address

30 OLD LYMAN RD
SOUTH HADLEY MA
01075-2630
US

V. Phone/Fax

Practice location:
  • Phone: 413-533-7140
  • Fax: 413-538-9757
Mailing address:
  • Phone: 413-533-7140
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberLCSW 219138
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: