Provider Demographics
NPI:1508465782
Name:INTROCASO, GENEVIEVE THERESA (LCSW)
Entity Type:Individual
Prefix:MS
First Name:GENEVIEVE
Middle Name:THERESA
Last Name:INTROCASO
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 1:1110 35TH LN FL 1
Mailing Address - Street 2:
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32960-6514
Mailing Address - Country:US
Mailing Address - Phone:772-567-5551
Mailing Address - Fax:772-567-9308
Practice Address - Street 1:1110 35TH LN FL 1
Practice Address - Street 2:
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32960-6514
Practice Address - Country:US
Practice Address - Phone:772-567-5551
Practice Address - Fax:772-567-9308
Is Sole Proprietor?:No
Enumeration Date:2020-10-20
Last Update Date:2020-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL150861041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical