Provider Demographics
NPI:1699981258
Name:GERONIMO, ANNE SLATER (LCMFT)
Entity type:Individual
Prefix:MS
First Name:ANNE
Middle Name:SLATER
Last Name:GERONIMO
Suffix:
Gender:F
Credentials:LCMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:215 LAKEVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:EDGEWATER
Mailing Address - State:MD
Mailing Address - Zip Code:21037-4818
Mailing Address - Country:US
Mailing Address - Phone:240-354-3001
Mailing Address - Fax:
Practice Address - Street 1:8811 COLESVILLE RD
Practice Address - Street 2:SUITE 106
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20910-4343
Practice Address - Country:US
Practice Address - Phone:240-354-3001
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDMD136106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist