Michael Gennaco
Individual provider Active NPI Behavior Analyst · Portland, ME
NPI 1508724006 · NPPES record last updated Jan 13, 2026
Key facts
- NPI
- 1508724006
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Behavior Analyst 103K00000X
- License
- 1-24-74050 (ME)
- Practice address
- 1250 Forest Ave Ste 301
Portland, ME 04103-1884 - Phone
- (888) 477-3324
- NPI assigned
- Jan 13, 2026
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Behavior Analyst | 103K00000X | 1-24-74050 | ME | Yes |
Addresses
Primary practice location
1250 Forest Ave Ste 301
Portland, ME 04103-1884
Mailing address
42 Destinee LN Unit B
Naples, ME 04055-3157
Other providers in Portland, ME
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 13, 2026. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.