Provider Demographics
NPI:1881763076
Name:STANASZEK, GERARDA TERESA (ART THERAPIST)
Entity type:Individual
Prefix:
First Name:GERARDA
Middle Name:TERESA
Last Name:STANASZEK
Suffix:
Gender:F
Credentials:ART THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:119 COLLEGE AVE
Mailing Address - Street 2:#43
Mailing Address - City:SOMERVILLE
Mailing Address - State:MA
Mailing Address - Zip Code:02144-1960
Mailing Address - Country:US
Mailing Address - Phone:617-628-3750
Mailing Address - Fax:
Practice Address - Street 1:30 BOSTON ST
Practice Address - Street 2:
Practice Address - City:LYNN
Practice Address - State:MA
Practice Address - Zip Code:01904-2540
Practice Address - Country:US
Practice Address - Phone:781-592-5691
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor