Basic Information
| Provider Information | |||||||||
| NPI: | 1215277348 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GENNARO | ||||||||
| FirstName: | MELINA | ||||||||
| MiddleName: | MACCA | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1639 FORUM PL STE 7 | ||||||||
| Address2: | |||||||||
| City: | WEST PALM BEACH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 334012330 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5617128821 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2976 S MILITARY TRL | ||||||||
| Address2: | |||||||||
| City: | WEST PALM BEACH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 334159200 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5614651642 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/27/2013 | ||||||||
| LastUpdateDate: | 05/06/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106H00000X | MT 2735 | FL | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.