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General NPI Number Information
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NPI Number | 1376862847
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Entity Type | Individual
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Provider Name | JOSEPH S GERACE LCSW-R
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Gender | Male
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Dates
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Enumeration Date | 05/24/2010
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Last Update Date | 05/24/2010
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Provider Practice Location Address
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Address Line | 405 GIFFORD ST
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City | SYRACUSE
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State | NY
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Zip | 13204-3203
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Country | US
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Telephone | 315-476-3157
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Fax |
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Provider Business Mailing Address
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Address Line | 8 ELM HILL WAY
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City | CAMILLUS
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State | NY
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Zip | 13031-1610
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Country | US
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Telephone | 315-488-8373
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | R034625-1
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License Number State | NY
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