Provider Demographics
NPI:1649814047
Name:CROSSIN, GENNA
Entity type:Individual
Prefix:
First Name:GENNA
Middle Name:
Last Name:CROSSIN
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 1:1166 S CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:APOPKA
Mailing Address - State:FL
Mailing Address - Zip Code:32703-3019
Mailing Address - Country:US
Mailing Address - Phone:407-793-8104
Mailing Address - Fax:
Practice Address - Street 1:1166 S CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:APOPKA
Practice Address - State:FL
Practice Address - Zip Code:32703-3019
Practice Address - Country:US
Practice Address - Phone:407-793-8104
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-30
Last Update Date:2019-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
0OtherNON