Provider Demographics
NPI:1801844907
Name:GENOVESE, ANNETTE (LCSW)
Entity type:Individual
Prefix:
First Name:ANNETTE
Middle Name:
Last Name:GENOVESE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:ANNETTE
Other - Middle Name:
Other - Last Name:GENOVESE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCSW
Mailing Address - Street 1:40885 QUAIL ST
Mailing Address - Street 2:
Mailing Address - City:MATTAWAN
Mailing Address - State:MI
Mailing Address - Zip Code:49071-8350
Mailing Address - Country:US
Mailing Address - Phone:201-615-1540
Mailing Address - Fax:
Practice Address - Street 1:40885 QUAIL ST
Practice Address - Street 2:
Practice Address - City:MATTAWAN
Practice Address - State:MI
Practice Address - Zip Code:49071-8350
Practice Address - Country:US
Practice Address - Phone:201-615-1540
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-04
Last Update Date:2023-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC052256001041C0700X
MI69010854911041C0700X
TNTNSW75261041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical