Provider Demographics
NPI:1437401924
Name:GENOVESE, SHANNON MARIE (LCSW)
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:MARIE
Last Name:GENOVESE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:417 BURNT HILL RD
Mailing Address - Street 2:
Mailing Address - City:ROSCOE
Mailing Address - State:NY
Mailing Address - Zip Code:12776-5421
Mailing Address - Country:US
Mailing Address - Phone:845-292-8770
Mailing Address - Fax:
Practice Address - Street 1:230 ROCK HILL DR
Practice Address - Street 2:
Practice Address - City:ROCK HILL
Practice Address - State:NY
Practice Address - Zip Code:12775-6617
Practice Address - Country:US
Practice Address - Phone:845-342-5789
Practice Address - Fax:845-231-6078
Is Sole Proprietor?:No
Enumeration Date:2012-10-08
Last Update Date:2022-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker