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General NPI Number Information
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NPI Number | 1629805742
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Entity Type | Individual
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Provider Name | MARISSA CATHERINE GENOVESE PMHNP-BC
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Gender | Female
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Dates
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Enumeration Date | 09/14/2024
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Last Update Date | 10/09/2024
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Provider Practice Location Address
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Address Line | 1530 UNION RD STE A
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City | GASTONIA
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State | NC
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Zip | 28054-2201
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Country | US
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Telephone | 704-867-6188
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Fax | 704-866-4437
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Provider Business Mailing Address
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Address Line | 1530 UNION RD STE A
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City | GASTONIA
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State | NC
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Zip | 28054-2201
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Country | US
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Telephone | 704-867-6188
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Fax | 704-866-4437
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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 | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | F405932
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 373407
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License Number State | NC
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Taxonomy #3
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 849209
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License Number State | NY
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Taxonomy #4
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 2024041601
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License Number State | NC
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Taxonomy #5
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 5020970
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License Number State | NC
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