Provider Demographics
NPI:1124002977
Name:GENOVA, CAROL A (RN CADC)
Entity Type:Individual
Prefix:MRS
First Name:CAROL
Middle Name:A
Last Name:GENOVA
Suffix:
Gender:F
Credentials:RN CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:88 GRANDVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:WTBY
Mailing Address - State:CT
Mailing Address - Zip Code:06708-2509
Mailing Address - Country:US
Mailing Address - Phone:203-573-7500
Mailing Address - Fax:203-573-6575
Practice Address - Street 1:88 GRANDVIEW AVE
Practice Address - Street 2:
Practice Address - City:WATERBURY
Practice Address - State:CT
Practice Address - Zip Code:06708-2509
Practice Address - Country:US
Practice Address - Phone:203-573-7500
Practice Address - Fax:203-573-6575
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000132101YA0400X
CTE47103163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered163W00000XNursing Service ProvidersRegistered Nurse