Provider Demographics
NPI:1699327908
Name:URENA, GENESIS (LCSW)
Entity type:Individual
Prefix:MR
First Name:GENESIS
Middle Name:
Last Name:URENA
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:GENESIS
Other - Middle Name:
Other - Last Name:URENA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:GENESIS URENA, LCSW
Mailing Address - Street 1:245 AZALEA DR
Mailing Address - Street 2:
Mailing Address - City:NEW MILFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:07646-2530
Mailing Address - Country:US
Mailing Address - Phone:646-481-4485
Mailing Address - Fax:
Practice Address - Street 1:22-08 ROUTE 208
Practice Address - Street 2:
Practice Address - City:FAIR LAWN
Practice Address - State:NJ
Practice Address - Zip Code:07410-2609
Practice Address - Country:US
Practice Address - Phone:201-956-6363
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-16
Last Update Date:2023-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
104100000X
NY107263-01104100000X
NY0955271041C0700X
NJ44SL06609900104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker