Healthcare Provider Details

I. General information

NPI: 1164414124
Provider Name (Legal Business Name): NICOLE GERACE LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: NICOLE GERACE LCSW, PLLC

II. Dates (important events)

Enumeration Date: 08/16/2005
Last Update Date: 04/20/2022
Certification Date: 04/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

56 SHEPARD STREET SUITE 1
WALTON NY
13856
US

IV. Provider business mailing address

PO BOX 365
WALTON NY
13856
US

V. Phone/Fax

Practice location:
  • Phone: 607-865-7931
  • Fax: 607-865-5790
Mailing address:
  • Phone: 607-865-7931
  • Fax: 607-865-5790

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: