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General NPI Number Information
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NPI Number | 1700259454
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Entity Type | Individual
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Provider Name | AMANDA GERACI LCSW
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Gender | Female
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Dates
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Enumeration Date | 11/03/2015
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Last Update Date | 11/03/2015
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Provider Practice Location Address
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Address Line | 2305 FAIRMOUNT AVE
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City | PHILADELPHIA
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State | PA
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Zip | 19130-2515
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Country | US
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Telephone | 267-282-1140
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Fax |
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Provider Business Mailing Address
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Address Line | 5006 CEDAR AVE
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City | PHILADELPHIA
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State | PA
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Zip | 19143-1653
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Country | US
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Telephone | 973-951-2299
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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 | CW018738
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License Number State | PA
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