Provider Demographics
NPI:1023788726
Name:GENERAZZO, EMILY J
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:J
Last Name:GENERAZZO
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 1:2100 CONSTITUTION BLVD STE 120
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34231-4146
Mailing Address - Country:US
Mailing Address - Phone:339-293-3253
Mailing Address - Fax:
Practice Address - Street 1:2100 CONSTITUTION BLVD STE 120
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34231-4146
Practice Address - Country:US
Practice Address - Phone:727-490-8109
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-15
Last Update Date:2025-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH24995101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health