Provider Demographics
NPI:1750198289
Name:OLMO, GENESIS M
Entity type:Individual
Prefix:
First Name:GENESIS
Middle Name:M
Last Name:OLMO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:GENESIS
Other - Middle Name:M
Other - Last Name:MUNIZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10 NEBRASKA ST UNIT 5
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01604-3672
Mailing Address - Country:US
Mailing Address - Phone:978-333-4201
Mailing Address - Fax:
Practice Address - Street 1:548 PARK AVE STE B
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01603-2537
Practice Address - Country:US
Practice Address - Phone:774-823-1500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-17
Last Update Date:2024-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health