Provider Demographics
NPI:1457414500
Name:GENNARELLI, TERI FULLER (LICSW)
Entity Type:Individual
Prefix:MRS
First Name:TERI
Middle Name:FULLER
Last Name:GENNARELLI
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4201 CONNECTICUT AVE NW
Mailing Address - Street 2:SUITE 300
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20008-1158
Mailing Address - Country:US
Mailing Address - Phone:202-624-0010
Mailing Address - Fax:202-624-0062
Practice Address - Street 1:4201 CONNECTICUT AVE NW
Practice Address - Street 2:SUITE 300
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20008-1158
Practice Address - Country:US
Practice Address - Phone:202-624-0010
Practice Address - Fax:202-624-0062
Is Sole Proprietor?:No
Enumeration Date:2006-12-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCLC500779511041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical