Provider Demographics
NPI:1316002678
Name:GENATT, DEBORAH (LCSW-R)
Entity Type:Individual
Prefix:MS
First Name:DEBORAH
Middle Name:
Last Name:GENATT
Suffix:
Gender:F
Credentials:LCSW-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9411 69TH AVE
Mailing Address - Street 2:#203
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375-5801
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:262 BRADLEYS CROSSING RD
Practice Address - Street 2:
Practice Address - City:EAST CHATHAM
Practice Address - State:NY
Practice Address - Zip Code:12060-3611
Practice Address - Country:US
Practice Address - Phone:518-392-6326
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR046439-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02309608Medicare ID - Type Unspecified