Provider Demographics
NPI:1689198848
Name:CINCOGRONO, GENNA RISUCCI (LMHC)
Entity Type:Individual
Prefix:
First Name:GENNA
Middle Name:RISUCCI
Last Name:CINCOGRONO
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:GENNA
Other - Middle Name:LYN
Other - Last Name:RISUCCI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMHC
Mailing Address - Street 1:115 W WOOLBRIGHT RD STE J
Mailing Address - Street 2:
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33435-5908
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1001 W COMMERCIAL BLVD
Practice Address - Street 2:
Practice Address - City:FT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33309-3107
Practice Address - Country:US
Practice Address - Phone:561-734-1818
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-31
Last Update Date:2022-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH15192101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health