Provider Demographics
NPI:1134369937
Name:GERACI, ANDREA LYNNE (ANDREA GERACI LAC)
Entity type:Individual
Prefix:MS
First Name:ANDREA
Middle Name:LYNNE
Last Name:GERACI
Suffix:
Gender:F
Credentials:ANDREA GERACI LAC
Other - Prefix:MS
Other - First Name:ANDREA
Other - Middle Name:LYNNE
Other - Last Name:GERACI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:ANDREA GERACI
Mailing Address - Street 1:7 IVY LANE
Mailing Address - Street 2:
Mailing Address - City:WALTHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02154-0215
Mailing Address - Country:US
Mailing Address - Phone:781-454-7605
Mailing Address - Fax:
Practice Address - Street 1:7 IVY LN
Practice Address - Street 2:
Practice Address - City:WALTHAM
Practice Address - State:MA
Practice Address - Zip Code:02452-4726
Practice Address - Country:US
Practice Address - Phone:781-454-7605
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-06
Last Update Date:2009-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA219528171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist