=====================================================
General NPI Number Information
=====================================================
NPI Number | 1013219401
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KARA GERACE LCSW
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/17/2010
-----------------------------------------------------
Last Update Date | 11/17/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 23 HALL LN
-----------------------------------------------------
City | NEWTOWN
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06470-1329
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 203-241-1657
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 23 HALL LN
-----------------------------------------------------
City | NEWTOWN
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06470-1329
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 203-241-1657
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | 006976
-----------------------------------------------------
License Number State | CT
-----------------------------------------------------