Provider Demographics
NPI:1003912221
Name:GEOFF GENSER, LCSW, LLC
Entity Type:Organization
Organization Name:GEOFF GENSER, LCSW, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OUTPATIENT THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:GEOFFREY
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:GENSER
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:860-570-0877
Mailing Address - Street 1:15 N MAIN ST
Mailing Address - Street 2:3RD FLOOR
Mailing Address - City:WEST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06107-1974
Mailing Address - Country:US
Mailing Address - Phone:860-570-0877
Mailing Address - Fax:860-264-4737
Practice Address - Street 1:15 N MAIN ST
Practice Address - Street 2:3RD FLOOR
Practice Address - City:WEST HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06107-1974
Practice Address - Country:US
Practice Address - Phone:860-570-0877
Practice Address - Fax:860-264-4737
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-15
Last Update Date:2008-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0053361041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTP3514264OtherOXFORD HEALTH PLAN
CT349753OtherAETNA
CT716456000OtherMAGELLAN
CT004243052Medicaid
CT140005336CT03OtherANTHEM BCBS
CT244683591OtherUNITED BEHAVIORAL HEALTH