Provider Demographics
NPI:1003145673
Name:MARY E GENKINS DSW LCSW PC
Entity Type:Organization
Organization Name:MARY E GENKINS DSW LCSW PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARY
Authorized Official - Middle Name:ELEANOR
Authorized Official - Last Name:GENKINS
Authorized Official - Suffix:
Authorized Official - Credentials:DSW LCSW
Authorized Official - Phone:212-838-9257
Mailing Address - Street 1:430 E 63RD ST
Mailing Address - Street 2:APT 12L
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10065-7994
Mailing Address - Country:US
Mailing Address - Phone:212-838-9257
Mailing Address - Fax:212-207-6615
Practice Address - Street 1:430 E 63RD ST
Practice Address - Street 2:APT 12L
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10065-7994
Practice Address - Country:US
Practice Address - Phone:212-838-9257
Practice Address - Fax:212-207-6615
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-10
Last Update Date:2012-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYPR020236-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty