Provider Demographics
NPI:1255771960
Name:GENNARO, JENNIFER ASHLEY (LMSW)
Entity type:Individual
Prefix:MISS
First Name:JENNIFER
Middle Name:ASHLEY
Last Name:GENNARO
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8269 E 23RD AVE STE 100B
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80238-3557
Mailing Address - Country:US
Mailing Address - Phone:720-316-8110
Mailing Address - Fax:
Practice Address - Street 1:8269 E 23RD AVE STE 100B
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80238-3557
Practice Address - Country:US
Practice Address - Phone:720-316-8110
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-26
Last Update Date:2021-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSLMSW8875104100000X
CO99243041041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO49705041Medicaid