Provider Demographics
NPI:1770689770
Name:GERONAZZO, MOLLY K (LPC)
Entity Type:Individual
Prefix:
First Name:MOLLY
Middle Name:K
Last Name:GERONAZZO
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:MARGOT
Other - Middle Name:K
Other - Last Name:GERONAZZO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPC
Mailing Address - Street 1:5470 SAMPLE WAY
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80919-2491
Mailing Address - Country:US
Mailing Address - Phone:719-640-0793
Mailing Address - Fax:
Practice Address - Street 1:620 S CASCADE AVE STE C
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80903-4050
Practice Address - Country:US
Practice Address - Phone:719-640-0793
Practice Address - Fax:719-471-2023
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-16
Last Update Date:2019-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO3821101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional