Provider Demographics
NPI:1982069886
Name:GEISERT, MICHAEL W (LCSW LCADC)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:W
Last Name:GEISERT
Suffix:
Gender:M
Credentials:LCSW LCADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 201
Mailing Address - Street 2:
Mailing Address - City:BORDENTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:08505-0201
Mailing Address - Country:US
Mailing Address - Phone:609-310-0076
Mailing Address - Fax:
Practice Address - Street 1:325 JERSEY ST
Practice Address - Street 2:
Practice Address - City:TRENTON
Practice Address - State:NJ
Practice Address - Zip Code:08611-3113
Practice Address - Country:US
Practice Address - Phone:609-310-0076
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-18
Last Update Date:2022-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC5428600101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ472741744OtherPRIVATE INSURANCE