Provider Demographics
NPI:1154639870
Name:GENEREUX, SARAH DAWN (M,A,)
Entity Type:Individual
Prefix:MRS
First Name:SARAH
Middle Name:DAWN
Last Name:GENEREUX
Suffix:
Gender:F
Credentials:M,A,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3223 N 169TH ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68116-2650
Mailing Address - Country:US
Mailing Address - Phone:402-813-2235
Mailing Address - Fax:402-502-1282
Practice Address - Street 1:3223 N 169TH ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68116-2650
Practice Address - Country:US
Practice Address - Phone:402-813-2235
Practice Address - Fax:402-502-1282
Is Sole Proprietor?:No
Enumeration Date:2010-09-15
Last Update Date:2010-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health