Provider Demographics
NPI:1639590276
Name:GENEST, NORMAND
Entity Type:Individual
Prefix:
First Name:NORMAND
Middle Name:
Last Name:GENEST
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 WEST CHESTNUT STREET
Mailing Address - Street 2:
Mailing Address - City:BROCKTON
Mailing Address - State:MA
Mailing Address - Zip Code:02301
Mailing Address - Country:US
Mailing Address - Phone:508-580-4691
Mailing Address - Fax:
Practice Address - Street 1:250 COMMERCIAL ST
Practice Address - Street 2:SUITE 330
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01608-1726
Practice Address - Country:US
Practice Address - Phone:508-752-4665
Practice Address - Fax:508-752-0947
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-28
Last Update Date:2015-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor