Provider Demographics
NPI:1598050437
Name:GENNARO, HARRIETT JANE (LADC)
Entity Type:Individual
Prefix:
First Name:HARRIETT
Middle Name:JANE
Last Name:GENNARO
Suffix:
Gender:F
Credentials:LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 YOUTH CENTER ROAD
Mailing Address - Street 2:
Mailing Address - City:ELKO
Mailing Address - State:NV
Mailing Address - Zip Code:89803
Mailing Address - Country:US
Mailing Address - Phone:775-934-1619
Mailing Address - Fax:
Practice Address - Street 1:100 YOUTH CENTER ROAD
Practice Address - Street 2:
Practice Address - City:ELKO
Practice Address - State:NV
Practice Address - Zip Code:89803
Practice Address - Country:US
Practice Address - Phone:775-934-1619
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-17
Last Update Date:2011-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV01266-L101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)