Provider Demographics
NPI:1952753048
Name:GEFFEN, MICHELLE ALYSSA (MA)
Entity Type:Individual
Prefix:MS
First Name:MICHELLE
Middle Name:ALYSSA
Last Name:GEFFEN
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 FALLS BLVD
Mailing Address - Street 2:APARTMENT 2332
Mailing Address - City:QUINCY
Mailing Address - State:MA
Mailing Address - Zip Code:02169-8178
Mailing Address - Country:US
Mailing Address - Phone:516-987-7326
Mailing Address - Fax:
Practice Address - Street 1:500 FALLS BLVD
Practice Address - Street 2:APARTMENT 2332
Practice Address - City:QUINCY
Practice Address - State:MA
Practice Address - Zip Code:02169-8178
Practice Address - Country:US
Practice Address - Phone:516-987-7326
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-13
Last Update Date:2016-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health