Provider Demographics
NPI:1154138568
Name:LAUDERBAUGH, GENESEE (MS)
Entity type:Individual
Prefix:
First Name:GENESEE
Middle Name:
Last Name:LAUDERBAUGH
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3009 W GIRARD AVE APT 1
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19130-1270
Mailing Address - Country:US
Mailing Address - Phone:443-280-8673
Mailing Address - Fax:
Practice Address - Street 1:3009 W GIRARD AVE APT 1
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19130-1270
Practice Address - Country:US
Practice Address - Phone:443-280-8673
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-18
Last Update Date:2024-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health