| Doctor Name: | JACELYN MARIE GENNERO |
| NPI Number: | 1104839687 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | LMSW |
| License Number: | 6801085603 |
| Business Practice Address: | 2387 E Walton Blvd Auburn Hills, MI - 483261955 |
| Business Phone Number: | 2484756300 |
| Business Fax Number: | 2484756302 |
| Mailing Address: | 2387 E Walton Blvd, AUBURN HILLS |
| State: | MI |
| Postal Code: | 483261955 |
| Phone Number: | 2484756300 |
| Fax Number: | 2484756302 |
| NPI Enumeration Date: | 08/14/2006 |
| NPI Last Update Date: | 11/29/2010 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 1041C0700X |
| License Number: | 6801085603 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MI |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Social Worker |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | A social worker who holds a master |