MEDICARE: MS. PAIGE MARIE GESICKI 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	1041C0700X	Clinical Social Worker	149.020124	IL
2	1041C0700X	Clinical Social Worker	140.020124	IL
3	1041C0700X	Clinical Social Worker	44SC06093400	NJ

General Provider Information

NPI Number	:	1750861704
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. PAIGE MARIE GESICKI LCSW

Provider Business Mailing Address
First Line	:	9 N SALEM ST
Second Line	:
City	:	DOVER
State	:	NJ
Zip	:	07801-4185
Country	:	US
Telephone Number	:	201-841-0101
Fax Number	:

Provider Business Practice Location Address
First Line	:	9 N SALEM ST
Second Line	:
City	:	DOVER
State	:	NJ
Zip	:	07801-4185
Country	:	US
Telephone Number	:	201-841-0101
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/20/2018
Last Update Date	:	06/14/2023

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