Provider Demographics
NPI:1497173785
Name:GERACI, MARISSA (LMHC)
Entity Type:Individual
Prefix:MS
First Name:MARISSA
Middle Name:
Last Name:GERACI
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2401 BAYSHORE BLVD
Mailing Address - Street 2:UNIT 412
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33629
Mailing Address - Country:US
Mailing Address - Phone:813-675-7749
Mailing Address - Fax:813-867-3220
Practice Address - Street 1:730 S STERLING AVE
Practice Address - Street 2:SUITE 204
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33609
Practice Address - Country:US
Practice Address - Phone:813-675-7749
Practice Address - Fax:813-867-3220
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-03
Last Update Date:2019-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
FLMH13719101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health