Provider Demographics
NPI:1831554781
Name:MANAHAN, GERALDINE MOORE (MSW, LCSW)
Entity type:Individual
Prefix:MS
First Name:GERALDINE
Middle Name:MOORE
Last Name:MANAHAN
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:313 N AURORA ST
Mailing Address - Street 2:
Mailing Address - City:ITHACA
Mailing Address - State:NY
Mailing Address - Zip Code:14850-4201
Mailing Address - Country:US
Mailing Address - Phone:607-229-3123
Mailing Address - Fax:
Practice Address - Street 1:5240 OAK HARBOR RD
Practice Address - Street 2:
Practice Address - City:TRUMANSBURG
Practice Address - State:NY
Practice Address - Zip Code:14886-9250
Practice Address - Country:US
Practice Address - Phone:078-820-1466
Practice Address - Fax:315-873-2883
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-19
Last Update Date:2022-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY72-093628104100000X
NJ44SL04689400104100000X
NY0893541041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker