Provider Demographics
NPI:1205046604
Name:GENO, SUZANNE MARIE (MACP, LADC)
Entity type:Individual
Prefix:
First Name:SUZANNE
Middle Name:MARIE
Last Name:GENO
Suffix:
Gender:F
Credentials:MACP, LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 PARSONAGE RD
Mailing Address - Street 2:PO BOX 250
Mailing Address - City:BRIDGEWATER
Mailing Address - State:VT
Mailing Address - Zip Code:05034
Mailing Address - Country:US
Mailing Address - Phone:802-672-4277
Mailing Address - Fax:802-672-4270
Practice Address - Street 1:SUNSET FARMS OFFICE BLDG
Practice Address - Street 2:3RD FLOOR SUITE 9
Practice Address - City:WOODSTOCK
Practice Address - State:VT
Practice Address - Zip Code:05091
Practice Address - Country:US
Practice Address - Phone:802-672-4277
Practice Address - Fax:802-672-4270
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT460101Y00000X
VT81101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101Y00000XBehavioral Health & Social Service ProvidersCounselor
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1002988Medicaid
VT1002988Medicaid