Provider Demographics
NPI:1417095035
Name:MUSCARNERE, GERALDINE C (R-ACSW)
Entity Type:Individual
Prefix:MRS
First Name:GERALDINE
Middle Name:C
Last Name:MUSCARNERE
Suffix:
Gender:F
Credentials:R-ACSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27 HALSEY ST
Mailing Address - Street 2:
Mailing Address - City:ISLANDIA
Mailing Address - State:NY
Mailing Address - Zip Code:11749-1717
Mailing Address - Country:US
Mailing Address - Phone:631-582-4575
Mailing Address - Fax:
Practice Address - Street 1:27 HALSEY ST
Practice Address - Street 2:
Practice Address - City:ISLANDIA
Practice Address - State:NY
Practice Address - Zip Code:11749-1717
Practice Address - Country:US
Practice Address - Phone:631-582-4575
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR046294-1101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1N0W985710Medicare ID - Type Unspecified