Provider Demographics
NPI:1801501267
Name:GEGUZIS, JESSE (LSW, MED)
Entity type:Individual
Prefix:
First Name:JESSE
Middle Name:
Last Name:GEGUZIS
Suffix:
Gender:M
Credentials:LSW, MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4614 BALTIMORE AVE APT 2R
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19143-6603
Mailing Address - Country:US
Mailing Address - Phone:347-217-3367
Mailing Address - Fax:
Practice Address - Street 1:401 S 2ND ST STE 401
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19147-1612
Practice Address - Country:US
Practice Address - Phone:609-225-9641
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-19
Last Update Date:2023-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW139976104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker