Provider Demographics
NPI:1063897114
Name:GENRE, CHARLES (LMHC, LPC)
Entity type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:
Last Name:GENRE
Suffix:
Gender:M
Credentials:LMHC, LPC
Other - Prefix:
Other - First Name:CHUCK
Other - Middle Name:
Other - Last Name:GENRE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LMHC, LPC
Mailing Address - Street 1:33 LEAD MINE RD
Mailing Address - Street 2:
Mailing Address - City:LEVERETT
Mailing Address - State:MA
Mailing Address - Zip Code:01054-9524
Mailing Address - Country:US
Mailing Address - Phone:413-200-9291
Mailing Address - Fax:
Practice Address - Street 1:33 LEAD MINE RD
Practice Address - Street 2:
Practice Address - City:LEVERETT
Practice Address - State:MA
Practice Address - Zip Code:01054-9524
Practice Address - Country:US
Practice Address - Phone:413-200-9291
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-29
Last Update Date:2023-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA5499101YP2500X
MA10000268101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional