Provider Demographics
NPI:1164414124
Name:GERACE, NICOLE (LCSW)
Entity Type:Individual
Prefix:MS
First Name:NICOLE
Middle Name:
Last Name:GERACE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:NICOLE
Other - Middle Name:
Other - Last Name:GERACE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW, PLLC
Mailing Address - Street 1:PO BOX 365
Mailing Address - Street 2:
Mailing Address - City:WALTON
Mailing Address - State:NY
Mailing Address - Zip Code:13856
Mailing Address - Country:US
Mailing Address - Phone:607-865-7931
Mailing Address - Fax:607-865-5790
Practice Address - Street 1:56 SHEPARD STREET
Practice Address - Street 2:SUITE 1
Practice Address - City:WALTON
Practice Address - State:NY
Practice Address - Zip Code:13856
Practice Address - Country:US
Practice Address - Phone:607-865-7931
Practice Address - Fax:607-865-5790
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-16
Last Update Date:2022-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
Q25153Medicare UPIN
9304275552030Medicare ID - Type Unspecified