Provider Demographics
NPI:1568974673
Name:GENARDO, JOHN (LCMHC)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:GENARDO
Suffix:
Gender:M
Credentials:LCMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:395 MAIN ST STE 1
Mailing Address - Street 2:
Mailing Address - City:ONEONTA
Mailing Address - State:NY
Mailing Address - Zip Code:13820-1955
Mailing Address - Country:US
Mailing Address - Phone:607-287-0058
Mailing Address - Fax:
Practice Address - Street 1:395 MAIN ST STE 1
Practice Address - Street 2:
Practice Address - City:ONEONTA
Practice Address - State:NY
Practice Address - Zip Code:13820-1955
Practice Address - Country:US
Practice Address - Phone:160-728-7005
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-30
Last Update Date:2023-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010193101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health