Provider Demographics
NPI:1922130517
Name:GENNA, CATHERINE WATSON (BS, IBCLC)
Entity Type:Individual
Prefix:MRS
First Name:CATHERINE
Middle Name:WATSON
Last Name:GENNA
Suffix:
Gender:F
Credentials:BS, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8315 98TH ST APT 1U
Mailing Address - Street 2:
Mailing Address - City:WOODHAVEN
Mailing Address - State:NY
Mailing Address - Zip Code:11421-1664
Mailing Address - Country:US
Mailing Address - Phone:718-846-2323
Mailing Address - Fax:
Practice Address - Street 1:8315 98TH ST APT 1U
Practice Address - Street 2:
Practice Address - City:WOODHAVEN
Practice Address - State:NY
Practice Address - Zip Code:11421-1664
Practice Address - Country:US
Practice Address - Phone:718-846-2323
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-10
Last Update Date:2011-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0896037OtherAETNA PROVIDER ID