Healthcare Provider Details

I. General information

NPI: 1801844907
Provider Name (Legal Business Name): ANNETTE GENOVESE LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ANNETTE GENOVESE LCSW

II. Dates (important events)

Enumeration Date: 05/04/2006
Last Update Date: 12/08/2023
Certification Date: 12/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40885 QUAIL ST
MATTAWAN MI
49071-8350
US

IV. Provider business mailing address

40885 QUAIL ST
MATTAWAN MI
49071-8350
US

V. Phone/Fax

Practice location:
  • Phone: 201-615-1540
  • Fax:
Mailing address:
  • Phone: 201-615-1540
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number44SC05225600
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6901085491
License Number StateMI
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberTNSW7526
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: