Healthcare Provider Details

I. General information

NPI: 1548728520
Provider Name (Legal Business Name): GENNEW INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/07/2019
Last Update Date: 04/02/2026
Certification Date: 04/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 EASTBROOK RD STE 101
DEDHAM MA
02026-2083
US

IV. Provider business mailing address

30 EASTBROOK RD STE 101
DEDHAM MA
02026-2083
US

V. Phone/Fax

Practice location:
  • Phone: 857-293-5020
  • Fax: 857-226-8772
Mailing address:
  • Phone: 857-293-5020
  • Fax: 857-226-8772

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: MR. THADDIEUS M SARPY JR.
Title or Position: VICE PRESIDENT / CLINICAL DIRECTOR
Credential: LMHC
Phone: 857-293-5020