Provider Demographics
NPI:1518603117
Name:NELSON, GENA CHRISTINE (LMHC)
Entity Type:Individual
Prefix:
First Name:GENA
Middle Name:CHRISTINE
Last Name:NELSON
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:GENA
Other - Middle Name:CHRISTINE
Other - Last Name:BINOTTO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:61 STATE HIGHWAY 72
Mailing Address - Street 2:
Mailing Address - City:POTSDAM
Mailing Address - State:NY
Mailing Address - Zip Code:13676-3478
Mailing Address - Country:US
Mailing Address - Phone:315-212-1928
Mailing Address - Fax:
Practice Address - Street 1:44 PIERREPONT AVE
Practice Address - Street 2:393 VH EXT
Practice Address - City:POTSDAM
Practice Address - State:NY
Practice Address - Zip Code:13676
Practice Address - Country:US
Practice Address - Phone:315-212-1928
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-07
Last Update Date:2023-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002888101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty