Provider Demographics
NPI:1639601313
Name:GENO, BRYNNE
Entity Type:Individual
Prefix:
First Name:BRYNNE
Middle Name:
Last Name:GENO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7939 JEFFERSON HWY
Mailing Address - Street 2:APT D103
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70809-1269
Mailing Address - Country:US
Mailing Address - Phone:225-454-0712
Mailing Address - Fax:
Practice Address - Street 1:7939 JEFFERSON HWY
Practice Address - Street 2:APT D103
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70809-1269
Practice Address - Country:US
Practice Address - Phone:225-454-0712
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-31
Last Update Date:2017-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician