| Dr. Genevieve Maltby Llc | |
|
861 N Madison St Ste 5 Rockford IL 61107-3058 | |
| (815) 871-2410 | |
| Not Available |
| Full Name | Dr. Genevieve Maltby Llc |
|---|---|
| Speciality | Social Worker |
| Location | 861 N Madison St Ste 5, Rockford, Illinois |
| Authorized Official Name and Position | Genevieve Maltby (OWNER) |
| Authorized Official Contact | 8159625585 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Dr. Genevieve Maltby Llc 861 N Madison St Ste 5 Rockford IL 61107-3058 Ph: (815) 871-2410 | Dr. Genevieve Maltby Llc 861 N Madison St Ste 5 Rockford IL 61107-3058 Ph: (815) 871-2410 |
| NPI Number | 1528780939 |
|---|---|
| Provider Enumeration Date | 09/13/2022 |
| Last Update Date | 09/13/2022 |
| Certification Date | 09/13/2022 |
| Medicare PECOS PAC ID | 9133596299 |
|---|---|
| Medicare Enrollment ID | O20221102000097 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1528780939 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
| Provider Name | Genevieve Maltby |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1649813452 PECOS PAC ID: 0244651677 Enrollment ID: I20200610002206 |
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