Provider Demographics
NPI:1366759391
Name:GERACE, JEANETTE FRANCIS (MA)
Entity type:Individual
Prefix:MRS
First Name:JEANETTE
Middle Name:FRANCIS
Last Name:GERACE
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 1:330 PETER AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10306-4614
Mailing Address - Country:US
Mailing Address - Phone:718-668-1274
Mailing Address - Fax:
Practice Address - Street 1:250 KRAMER AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10309-4227
Practice Address - Country:US
Practice Address - Phone:718-605-1189
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-13
Last Update Date:2017-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY018113-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist