Rosalie Genova, LCPC, CCS

Primary specialty

Adult Mental Health Clinic/CenterTaxonomy code 261QM0850X

Legal business name

ROSALIE GENOVA, LCPC, CCS

Practice address

1250 Forest Ave
Portland Wellness Cooperative, Unit 14, Suite 7
Portland, ME 04103

Phone

(207) 200-3789

NPI assigned

Nov 8, 2022

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Rosalie Genova, LCPC, CCSNPI 1386158558

Title

Owner

Phone

(207) 200-3789

Specialties & licenses 3

Addresses

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Rosalie Genova, LPC

  • Counselor
  • Brunswick, ME
  • NPI 1386158558
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1667865600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1667865600000",
    "number": "1134837222",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1250 FOREST AVE",
            "address_2": "PORTLAND WELLNESS COOPERATIVE, UNIT 14, SUITE 7",
            "city": "PORTLAND",
            "state": "ME",
            "postal_code": "04103"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1250 FOREST AVE",
            "address_2": "PORTLAND WELLNESS COOPERATIVE, UNIT 14, SUITE 7",
            "city": "PORTLAND",
            "state": "ME",
            "postal_code": "04103",
            "telephone_number": "207-200-3789"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ROSALIE GENOVA, LCPC, CCS",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-11-08",
        "last_updated": "2022-11-08",
        "certification_date": "2022-11-04",
        "status": "A",
        "authorized_official_last_name": "GENOVA",
        "authorized_official_first_name": "ROSALIE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "207-200-3789",
        "authorized_official_credential": "LCPC, CCS"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QM0850X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adult Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Adult Mental Health Clinic/Center in Portland, ME
• Providers in Portland, ME by specialty
• Adult Mental Health Clinic/Center in Maine

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 8, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.