MEDICARE: ANNETTE GENOVESE LCSW

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	1041C0700X	Clinical Social Worker	44SC05225600	NJ
2	1041C0700X	Clinical Social Worker	6901085491	MI
3	1041C0700X	Clinical Social Worker	TNSW7526	TN

General Provider Information

NPI Number	:	1801844907
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANNETTE GENOVESE LCSW

Provider Business Mailing Address
First Line	:	40885 QUAIL ST
Second Line	:
City	:	MATTAWAN
State	:	MI
Zip	:	49071-8350
Country	:	US
Telephone Number	:	201-615-1540
Fax Number	:

Provider Business Practice Location Address
First Line	:	40885 QUAIL ST
Second Line	:
City	:	MATTAWAN
State	:	MI
Zip	:	49071-8350
Country	:	US
Telephone Number	:	201-615-1540
Fax Number	:

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

Provider Enumeration Date	:	05/04/2006
Last Update Date	:	12/08/2023

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Directions to “ ANNETTE GENOVESE LCSW” Practice Location

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