Provider Demographics
NPI:1467575704
Name:GENOVESE, KATHY (R-LCSW)
Entity Type:Individual
Prefix:MS
First Name:KATHY
Middle Name:
Last Name:GENOVESE
Suffix:
Gender:F
Credentials:R-LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 STRAWBERRY LN
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:11743-2528
Mailing Address - Country:US
Mailing Address - Phone:631-427-3116
Mailing Address - Fax:
Practice Address - Street 1:19 STRAWBERRY LN
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:NY
Practice Address - Zip Code:11743-2528
Practice Address - Country:US
Practice Address - Phone:631-427-3116
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical