MEDICARE: PAMELA GERAGHTY, LCSW

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
1	261QM0850X	Adult Mental Health Clinic/Center

General Provider Information

NPI Number	:	1619512522
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PAMELA GERAGHTY, LCSW

Provider Business Mailing Address
First Line	:	2774 JEFFERSON ST
Second Line	:
City	:	CARLSBAD
State	:	CA
Zip	:	92008-1769
Country	:	US
Telephone Number	:	760-575-4512
Fax Number	:

Provider Business Practice Location Address
First Line	:	2774 JEFFERSON ST
Second Line	:
City	:	CARLSBAD
State	:	CA
Zip	:	92008-1769
Country	:	US
Telephone Number	:	760-575-4512
Fax Number	:	760-434-4789

Authorized Official
Title or Position	:	OWNER/THERAPIST
Name	:	PAMELA GERAGHTY LCSW
Credential	:	LCSW
Telephone Number	:	760-575-4512

Provider Enumeration Date	:	11/14/2019
Last Update Date	:	12/10/2019

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