Provider Demographics
NPI:1962982827
Name:GENUARIO, KIMBERLY MARIE (PHD)
Entity type:Individual
Prefix:DR
First Name:KIMBERLY
Middle Name:MARIE
Last Name:GENUARIO
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:3550 MARKET ST STE 2042
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19104-3329
Mailing Address - Country:US
Mailing Address - Phone:267-426-0149
Mailing Address - Fax:267-426-6012
Practice Address - Street 1:3401 CIVIC CENTER BLVD
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19104-4319
Practice Address - Country:US
Practice Address - Phone:336-457-4731
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-20
Last Update Date:2019-01-22
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent