Provider Demographics
NPI:1033214705
Name:GENSER, GEOFFREY SCOTT (LCSW)
Entity Type:Individual
Prefix:MR
First Name:GEOFFREY
Middle Name:SCOTT
Last Name:GENSER
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-14
Last Update Date:2008-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0053361041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004243052Medicaid
CT244683591OtherUNITED BEHAVIORAL HEALTH
CT349753OtherMHN/HMC
CT140005336CT03OtherANTHEM BC/BS
CTP3514264OtherOXFORD HEALTH PLANS