Provider Demographics
NPI:1902602337
Name:GENESIS THERAPY GROUP LLC
Entity type:Organization
Organization Name:GENESIS THERAPY GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHEILA
Authorized Official - Middle Name:
Authorized Official - Last Name:DELVALLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:516-585-1711
Mailing Address - Street 1:329 S OYSTER BAY RD # 636
Mailing Address - Street 2:
Mailing Address - City:PLAINVIEW
Mailing Address - State:NY
Mailing Address - Zip Code:11803-3301
Mailing Address - Country:US
Mailing Address - Phone:516-585-1711
Mailing Address - Fax:
Practice Address - Street 1:37 HUBBARD AVE UNIT 28
Practice Address - Street 2:
Practice Address - City:RIVERHEAD
Practice Address - State:NY
Practice Address - Zip Code:11901-2336
Practice Address - Country:US
Practice Address - Phone:516-585-1711
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-02-25
Last Update Date:2025-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty