Healthcare Provider Details

I. General information

NPI: 1275933194
Provider Name (Legal Business Name): GENEVA GROUP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/27/2014
Last Update Date: 08/27/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2130 MILLBURN AVE
MAPLEWOOD NJ
07040-3725
US

IV. Provider business mailing address

266 PHILLIPS TER
UNION NJ
07083-7246
US

V. Phone/Fax

Practice location:
  • Phone: 908-577-2771
  • Fax:
Mailing address:
  • Phone: 908-577-2771
  • Fax: 908-686-0356

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number44SC05584700
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number856759
License Number StateNJ

VIII. Authorized Official

Name: MR. JOSEPH UME
Title or Position: EXECUTIVE DIRETOR
Credential: LCSW
Phone: 908-577-2771