Provider Demographics
NPI:1609843507
Name:GEER, MARK F
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:F
Last Name:GEER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 RIVER ST
Mailing Address - Street 2:
Mailing Address - City:WELLESLEY
Mailing Address - State:MA
Mailing Address - Zip Code:02481-2098
Mailing Address - Country:US
Mailing Address - Phone:781-431-1177
Mailing Address - Fax:781-431-1181
Practice Address - Street 1:11 RIVER ST
Practice Address - Street 2:COLONY CARE BEHAVIORAL HEALTH
Practice Address - City:WELLESLEY
Practice Address - State:MA
Practice Address - Zip Code:02481-2098
Practice Address - Country:US
Practice Address - Phone:781-431-1177
Practice Address - Fax:781-431-1181
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2969103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0510645Medicaid
MA0510645Medicaid