Provider Demographics
NPI:1982665964
Name:GEANNIKIS, STARLA KAYE (LCSW)
Entity Type:Individual
Prefix:
First Name:STARLA
Middle Name:KAYE
Last Name:GEANNIKIS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 CUMBERLAND ST
Mailing Address - Street 2:
Mailing Address - City:BRUNSWICK
Mailing Address - State:ME
Mailing Address - Zip Code:04011-1932
Mailing Address - Country:US
Mailing Address - Phone:207-319-3079
Mailing Address - Fax:207-607-4015
Practice Address - Street 1:10 CUMBERLAND ST
Practice Address - Street 2:
Practice Address - City:BRUNSWICK
Practice Address - State:ME
Practice Address - Zip Code:04011-1932
Practice Address - Country:US
Practice Address - Phone:207-319-3079
Practice Address - Fax:207-607-4015
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-30
Last Update Date:2011-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC75051041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical