Healthcare Provider Details

I. General information

NPI: 1174711626
Provider Name (Legal Business Name): JOHN P. GEREMIA, LCSW-C, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/10/2007
Last Update Date: 10/10/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8331 LINCOLN DR
JESSUP MD
20794-9454
US

IV. Provider business mailing address

8331 LINCOLN DR
JESSUP MD
20794-9454
US

V. Phone/Fax

Practice location:
  • Phone: 410-799-5092
  • Fax: 410-799-5092
Mailing address:
  • Phone: 410-799-5092
  • Fax: 410-799-5092

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number10830
License Number StateMD

VIII. Authorized Official

Name: MR. JOHN P GEREMIA
Title or Position: PSYCHOTHERAPIST
Credential: LCSW-C
Phone: 410-799-5092