Basic Information
| Provider Information | |||||||||
| NPI: | 1972050359 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GENET | ||||||||
| FirstName: | CARLI | ||||||||
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| Credential: | MSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5 ROBERTS RD | ||||||||
| Address2: | |||||||||
| City: | DOVER | ||||||||
| State: | NH | ||||||||
| PostalCode: | 038204655 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6035470513 | ||||||||
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| Practice Location | |||||||||
| Address1: | 100 SHATTUCK WAY | ||||||||
| Address2: | |||||||||
| City: | NEWINGTON | ||||||||
| State: | NH | ||||||||
| PostalCode: | 03801 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6034316677 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/02/2016 | ||||||||
| LastUpdateDate: | 07/19/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
ID Information
| ID | Type | State | Issuer | Description | 3078870 | 05 | NH | MEDICAID |