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General NPI Number Information
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NPI Number | 1326810193
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Entity Type | Individual
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Provider Name | DEBORAH LYNN GENITO
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Gender | Female
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Dates
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Enumeration Date | 10/25/2023
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Last Update Date | 10/27/2023
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Provider Practice Location Address
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Address Line | 5 MEADOW STREET
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City | LAKE VILLE
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State | CT
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Zip | 06039
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Country | US
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Telephone | 530-228-4734
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Fax |
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Provider Business Mailing Address
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Address Line | 233 MANSFIELD GROVE RD UNIT 302
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City | EAST HAVEN
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State | CT
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Zip | 06512-4826
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Country | US
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Telephone | 530-228-4734
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 03-011130
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License Number State | CT
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