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General NPI Number Information
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NPI Number | 1740597137
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Entity Type | Organization
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Legal Business Name | GENESIS FAMILY SERVICES
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Dates
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Enumeration Date | 09/07/2010
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Last Update Date | 04/11/2022
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Provider Practice Location Address
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Address Line | 7350 NW 5TH ST
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City | PLANTATION
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State | FL
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Zip | 33317-1605
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Country | US
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Telephone | 954-404-6261
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Fax | 954-239-8612
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Provider Business Mailing Address
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Address Line | 7350 NW 5TH ST
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City | PLANTATION
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State | FL
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Zip | 33317-1605
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Country | US
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Telephone | 954-404-6261
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Fax | 954-239-8612
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Authorized Official
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Title or Position | CLINICAL DIRECTOR
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Name | ROSIE GONI
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Credential | LMFT
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Telephone | 954-404-6261
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | MT2410
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License Number State | FL
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