Provider Demographics
NPI:1275187619
Name:GERACI, MICHAEL DAVID (LCSW)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:DAVID
Last Name:GERACI
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2828 SUN VALLEY DR
Mailing Address - Street 2:
Mailing Address - City:PLAINFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60586-6651
Mailing Address - Country:US
Mailing Address - Phone:815-370-5479
Mailing Address - Fax:
Practice Address - Street 1:17154 W HOFF RD
Practice Address - Street 2:
Practice Address - City:ELWOOD
Practice Address - State:IL
Practice Address - Zip Code:60421-9440
Practice Address - Country:US
Practice Address - Phone:815-478-7625
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-24
Last Update Date:2019-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490211381041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical