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NPI Code Detail

MEDICARE: GERALYN MCNAMARA M.A., LMFT

MEDICARE:   GERALYN  MCNAMARA  M.A., LMFT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1106H00000XMarriage & Family Therapist001361GA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1001361OTHERGAGA LICENSED MARRIAGE AND FAMILY THERAPIST NUMBER 001361

General Provider Information

NPI Number : 1528377033
Entity Type Code : Individual
Provider Name (Legal Business Name) : GERALYN MCNAMARA M.A., LMFT
Provider Business Mailing Address
First Line : 280 BLUE MOON XING
Second Line : APT 434
City : POOLER
State : GA
Zip : 31322-9704
Country : US
Telephone Number : 206-437-1549
Fax Number :
Provider Business Practice Location Address
First Line : 2591 US HIGHWAY 17
Second Line : SUITE 304
City : RICHMOND HILL
State : GA
Zip : 31324-3864
Country : US
Telephone Number : 206-437-1549
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/30/2010
Last Update Date : 02/03/2015

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