1588029235 NPI number — MS. GENEVIEVE DEZYREE MARCEAU LMSW

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1588029235 NPI number — MS. GENEVIEVE DEZYREE MARCEAU LMSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MARCEAU
Provider First Name:
GENEVIEVE
Provider Middle Name:
DEZYREE
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
LMSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
HANES
Provider Other First Name:
GENEVIEVE
Provider Other Middle Name:
DEZYREE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
LLMSW
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1588029235
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/07/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1596 E M 21 STE 247
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OWOSSO
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48867-9050
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
989-270-6262
Provider Business Mailing Address Fax Number:
989-419-5940

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1596 E M 21 STE 247
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OWOSSO
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48867-9050
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
989-270-6262
Provider Business Practice Location Address Fax Number:
989-419-5940
Provider Enumeration Date:
12/23/2015

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:  6801115637 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1041C0700X , with the licence number: 6801102861 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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