Basic Information
Provider Information
NPI: 1164843181
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: GEFTER
FirstName: JULIA
MiddleName: REBECCA
NamePrefix: DR.
NameSuffix:  
Credential: PH.D
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1000 JEFFERSON ST.
Address2: STE. 2C
City: LYNCHBURG
State: VA
PostalCode: 24504
CountryCode: US
TelephoneNumber: 6173790496
FaxNumber: 6178070958
Practice Location
Address1: 872 MASSACHUSETTS AVE.
Address2: STE. 2-2, 2-7
City: CAMBRIDGE
State: MA
PostalCode: 02139
CountryCode: US
TelephoneNumber: 6173955806
FaxNumber:  
Other Information
ProviderEnumerationDate: 12/17/2013
LastUpdateDate: 03/03/2015
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
103T00000X9808MAY Behavioral Health & Social Service ProvidersPsychologist 

No ID Information.


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