Healthcare Provider Details

I. General information

NPI: 1538640123
Provider Name (Legal Business Name): ANGELA N GENOVESE LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/22/2018
Last Update Date: 08/22/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75 SYLVAN ST STE B102
DANVERS MA
01923-2764
US

IV. Provider business mailing address

75 SYLVAN ST STE B102
DANVERS MA
01923-2764
US

V. Phone/Fax

Practice location:
  • Phone: 978-880-8017
  • Fax:
Mailing address:
  • Phone: 978-774-7566
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number116083
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: