Provider Demographics
NPI:1629547435
Name:GENOVESE, ROSE (LMSW)
Entity Type:Individual
Prefix:MRS
First Name:ROSE
Middle Name:
Last Name:GENOVESE
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36 MAPLE RUN CT
Mailing Address - Street 2:
Mailing Address - City:JERICHO
Mailing Address - State:NY
Mailing Address - Zip Code:11753-2830
Mailing Address - Country:US
Mailing Address - Phone:516-640-4169
Mailing Address - Fax:516-640-4169
Practice Address - Street 1:36 MAPLE RUN CT
Practice Address - Street 2:
Practice Address - City:JERICHO
Practice Address - State:NY
Practice Address - Zip Code:11753-2830
Practice Address - Country:US
Practice Address - Phone:516-640-4169
Practice Address - Fax:516-640-4169
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-21
Last Update Date:2018-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0996561104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker