Provider Demographics
NPI:1982780698
Name:GENOVESE, HEATHER A (MS, ATR-BC, LCAT,LP)
Entity Type:Individual
Prefix:MS
First Name:HEATHER
Middle Name:A
Last Name:GENOVESE
Suffix:
Gender:F
Credentials:MS, ATR-BC, LCAT,LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:850 SEVENTH AVE
Mailing Address - Street 2:SUITE 906
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10019-5230
Mailing Address - Country:US
Mailing Address - Phone:212-289-5644
Mailing Address - Fax:212-289-5644
Practice Address - Street 1:850 SEVENTH AVE
Practice Address - Street 2:SUITE 906
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10019-5230
Practice Address - Country:US
Practice Address - Phone:212-289-5644
Practice Address - Fax:212-289-5644
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-27
Last Update Date:2011-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000004-1221700000X
NY000864102L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes102L00000XBehavioral Health & Social Service ProvidersPsychoanalyst
No221700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersArt Therapist