Healthcare Provider Details

I. General information

NPI: 1659966869
Provider Name (Legal Business Name): LAURA GERACIOTI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/09/2021
Last Update Date: 12/07/2023
Certification Date: 12/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9117 CINCINNATI COLUMBUS RD
WEST CHESTER OH
45069-3701
US

IV. Provider business mailing address

9117 CINCINNATI COLUMBUS RD
WEST CHESTER OH
45069-3701
US

V. Phone/Fax

Practice location:
  • Phone: 513-229-7585
  • Fax: 513-672-0792
Mailing address:
  • Phone: 513-229-7585
  • Fax: 513-672-0792

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberS.2208214
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: