Provider Demographics
NPI:1447597836
Name:GENEREUX, KATIE
Entity Type:Individual
Prefix:
First Name:KATIE
Middle Name:
Last Name:GENEREUX
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:275 LAKE SHORE DR
Mailing Address - Street 2:
Mailing Address - City:EAST FALMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02536-2701
Mailing Address - Country:US
Mailing Address - Phone:401-374-9407
Mailing Address - Fax:
Practice Address - Street 1:4 BARLOWS LANDING RD STE 13
Practice Address - Street 2:
Practice Address - City:POCASSET
Practice Address - State:MA
Practice Address - Zip Code:02559-1984
Practice Address - Country:US
Practice Address - Phone:508-563-5767
Practice Address - Fax:508-563-5774
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-06
Last Update Date:2013-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst