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General NPI Number Information
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NPI Number | 1902602337
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Entity Type | Organization
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Legal Business Name | GENESIS THERAPY GROUP LLC
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Dates
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Enumeration Date | 02/25/2025
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Last Update Date | 02/25/2025
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Provider Practice Location Address
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Address Line | 37 HUBBARD AVE UNIT 28
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City | RIVERHEAD
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State | NY
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Zip | 11901-2336
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Country | US
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Telephone | 516-585-1711
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Fax |
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Provider Business Mailing Address
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Address Line | 329 S OYSTER BAY RD # 636
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City | PLAINVIEW
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State | NY
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Zip | 11803-3301
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Country | US
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Telephone | 516-585-1711
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | SHEILA DELVALLE
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Credential |
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Telephone | 516-585-1711
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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 |
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License Number State |
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