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General NPI Number Information
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NPI Number | 1003145673
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Entity Type | Organization
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Legal Business Name | MARY E GENKINS DSW LCSW PC
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Dates
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Enumeration Date | 12/10/2009
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Last Update Date | 09/19/2012
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Provider Practice Location Address
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Address Line | 430 E 63RD ST APT 12L
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City | NEW YORK
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State | NY
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Zip | 10065-7994
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Country | US
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Telephone | 212-838-9257
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Fax | 212-207-6615
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Provider Business Mailing Address
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Address Line | 430 E 63RD ST APT 12L
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City | NEW YORK
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State | NY
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Zip | 10065-7994
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Country | US
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Telephone | 212-838-9257
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Fax | 212-207-6615
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MARY ELEANOR GENKINS
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Credential | DSW LCSW
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Telephone | 212-838-9257
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | PR020236-1
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License Number State | NY
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