Provider Demographics
NPI:1992485437
Name:GENEREUX, KATIE JO (MSW, JD)
Entity type:Individual
Prefix:
First Name:KATIE
Middle Name:JO
Last Name:GENEREUX
Suffix:
Gender:F
Credentials:MSW, JD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9906 EDGEHILL LN
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20901-2518
Mailing Address - Country:US
Mailing Address - Phone:563-343-4842
Mailing Address - Fax:
Practice Address - Street 1:10605 CONCORD STREET
Practice Address - Street 2:SUITE 207
Practice Address - City:KENSINGTON
Practice Address - State:MD
Practice Address - Zip Code:20895
Practice Address - Country:US
Practice Address - Phone:563-343-4842
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-19
Last Update Date:2023-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD30381104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker