1033214705 NPI number — MR. GEOFFREY SCOTT GENSER L.C.S.W.

Table of content: MR. GEOFFREY SCOTT GENSER L.C.S.W. (NPI 1033214705)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033214705 NPI number — MR. GEOFFREY SCOTT GENSER L.C.S.W.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GENSER
Provider First Name:
GEOFFREY
Provider Middle Name:
SCOTT
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
L.C.S.W.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1033214705
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/01/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
15 N MAIN ST
Provider Second Line Business Mailing Address:
3RD FLOOR
Provider Business Mailing Address City Name:
WEST HARTFORD
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06107-1974
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
860-570-0877
Provider Business Mailing Address Fax Number:
860-264-4737

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
15 N MAIN ST
Provider Second Line Business Practice Location Address:
3RD FLOOR
Provider Business Practice Location Address City Name:
WEST HARTFORD
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06107-1974
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
860-570-0877
Provider Business Practice Location Address Fax Number:
860-264-4737
Provider Enumeration Date:
09/14/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  005336 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 004243052 , issued by the state of ( CT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 244683591 . This is a "UNITED BEHAVIORAL HEALTH" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 349753 . This is a "MHN/HMC" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 140005336CT03 . This is a "ANTHEM BC/BS" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: P3514264 . This is a "OXFORD HEALTH PLANS" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com