Provider Demographics
NPI:1952435455
Name:GERATY, EDWARD M (LCSW-C)
Entity Type:Individual
Prefix:
First Name:EDWARD
Middle Name:M
Last Name:GERATY
Suffix:
Gender:M
Credentials:LCSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:114 OAKWAY RD
Mailing Address - Street 2:
Mailing Address - City:TIMONIUM
Mailing Address - State:MD
Mailing Address - Zip Code:21093-4339
Mailing Address - Country:US
Mailing Address - Phone:410-804-1934
Mailing Address - Fax:410-882-1079
Practice Address - Street 1:2 OAKWAY RD
Practice Address - Street 2:
Practice Address - City:TIMONIUM
Practice Address - State:MD
Practice Address - Zip Code:21093-4236
Practice Address - Country:US
Practice Address - Phone:410-804-1934
Practice Address - Fax:410-882-1079
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-15
Last Update Date:2021-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD100091041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDBK820001OtherCAREFIRST BLUECROSS BLUESHIELD
MD548302600Medicaid
MHS8030008OtherPROVIDER NUMBER