Provider Demographics
NPI:1811585318
Name:GERACI, MELISSA WYE (LMSW)
Entity Type:Individual
Prefix:DR
First Name:MELISSA
Middle Name:WYE
Last Name:GERACI
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7993 N SILVER SAGE
Mailing Address - Street 2:
Mailing Address - City:PRESCOTT VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:86315-3018
Mailing Address - Country:US
Mailing Address - Phone:505-659-9622
Mailing Address - Fax:
Practice Address - Street 1:7993 N SILVER SAGE
Practice Address - Street 2:
Practice Address - City:PRESCOTT VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:86315-3018
Practice Address - Country:US
Practice Address - Phone:505-659-9622
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-10
Last Update Date:2021-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLMSW-175831041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical