Provider Demographics
NPI:1841804671
Name:MARINACCIO, GERALDINE ANN
Entity Type:Individual
Prefix:
First Name:GERALDINE
Middle Name:ANN
Last Name:MARINACCIO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5202 DAYBROOK CIR APT 164
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21237-5076
Mailing Address - Country:US
Mailing Address - Phone:443-337-4110
Mailing Address - Fax:
Practice Address - Street 1:1015 PULASKI HWY
Practice Address - Street 2:
Practice Address - City:JOPPA
Practice Address - State:MD
Practice Address - Zip Code:21085-3918
Practice Address - Country:US
Practice Address - Phone:410-670-8012
Practice Address - Fax:833-470-0753
Is Sole Proprietor?:No
Enumeration Date:2020-08-31
Last Update Date:2020-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD1863101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)