Provider Demographics
NPI:1619512522
Name:PAMELA GERAGHTY, LCSW
Entity Type:Organization
Organization Name:PAMELA GERAGHTY, LCSW
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:GERAGHTY
Authorized Official - Last Name:LCSW
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:760-575-4512
Mailing Address - Street 1:2774 JEFFERSON ST
Mailing Address - Street 2:
Mailing Address - City:CARLSBAD
Mailing Address - State:CA
Mailing Address - Zip Code:92008-1769
Mailing Address - Country:US
Mailing Address - Phone:760-575-4512
Mailing Address - Fax:
Practice Address - Street 1:2774 JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:CARLSBAD
Practice Address - State:CA
Practice Address - Zip Code:92008-1769
Practice Address - Country:US
Practice Address - Phone:760-575-4512
Practice Address - Fax:760-434-4789
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-14
Last Update Date:2019-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health