Healthcare Provider Details

I. General information

NPI: 1063722098
Provider Name (Legal Business Name): ELIZABETH CLAIRE GENEREUX MSW, LSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LIBBY GENEREUX

II. Dates (important events)

Enumeration Date: 10/08/2010
Last Update Date: 03/23/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

137 HOWARD ST
EAGLE CO
81631
US

IV. Provider business mailing address

PO BOX 40
GLENWOOD SPRINGS CO
81602-0040
US

V. Phone/Fax

Practice location:
  • Phone: 970-328-6969
  • Fax: 970-328-6329
Mailing address:
  • Phone: 970-945-2241
  • Fax: 970-945-5523

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number836
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: