Provider Demographics
NPI:1629543855
Name:GENEROU, LAURA LYNN (LCSW)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:LYNN
Last Name:GENEROU
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 1:7602 STATE HIGHWAY M123
Mailing Address - Street 2:
Mailing Address - City:NEWBERRY
Mailing Address - State:MI
Mailing Address - Zip Code:49868-8128
Mailing Address - Country:US
Mailing Address - Phone:906-322-9576
Mailing Address - Fax:906-293-7150
Practice Address - Street 1:7602 STATE HIGHWAY M123
Practice Address - Street 2:
Practice Address - City:NEWBERRY
Practice Address - State:MI
Practice Address - Zip Code:49868-8128
Practice Address - Country:US
Practice Address - Phone:906-322-9576
Practice Address - Fax:906-293-7150
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-03
Last Update Date:2022-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical