MEDICARE: TINA JEAN GENARO LPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101Y00000X	Counselor	0701003792	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1154354819
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TINA JEAN GENARO LPC

Provider Business Mailing Address
First Line	:	4212 CYPRESS PARK DR STE F
Second Line	:
City	:	ROANOKE
State	:	VA
Zip	:	24018-8417
Country	:	US
Telephone Number	:	540-283-5215
Fax Number	:	540-400-8177

Provider Business Practice Location Address
First Line	:	4212 CYPRESS PARK DR STE F
Second Line	:
City	:	ROANOKE
State	:	VA
Zip	:	24018-8417
Country	:	US
Telephone Number	:	540-283-5215
Fax Number	:	540-400-8177

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/08/2006
Last Update Date	:	03/28/2017

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