Provider Demographics
NPI:1497810055
Name:GENETTI, PHYLLIS (MA MHC)
Entity Type:Individual
Prefix:MS
First Name:PHYLLIS
Middle Name:
Last Name:GENETTI
Suffix:
Gender:F
Credentials:MA MHC
Other - Prefix:MS
Other - First Name:DEE PHYLIS
Other - Middle Name:
Other - Last Name:GENETTI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MA MCH
Mailing Address - Street 1:19 MARCUS RD
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:01887-1508
Mailing Address - Country:US
Mailing Address - Phone:978-658-4191
Mailing Address - Fax:
Practice Address - Street 1:27 CONGRESS ST
Practice Address - Street 2:SUITE 105
Practice Address - City:SALEM
Practice Address - State:MA
Practice Address - Zip Code:01970-7309
Practice Address - Country:US
Practice Address - Phone:978-740-1515
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health