Provider Demographics
NPI:1619031358
Name:GENOVA, JAMES ERIC (LCSW)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:ERIC
Last Name:GENOVA
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 JOYCE RD
Mailing Address - Street 2:
Mailing Address - City:EASTCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:10709-1417
Mailing Address - Country:US
Mailing Address - Phone:914-961-1123
Mailing Address - Fax:
Practice Address - Street 1:335 COLUMBUS AVE
Practice Address - Street 2:
Practice Address - City:TUCKAHOE
Practice Address - State:NY
Practice Address - Zip Code:10707-1706
Practice Address - Country:US
Practice Address - Phone:914-497-5973
Practice Address - Fax:914-779-5802
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0748261041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical