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Genesis Roque , MS, LAPC

Counselor - Professional β€’ Hazleton, PA

Active NPI 1659057370 Individual Practitioner Female Practitioner
Practice location in NPPES

750 E Broad St
Hazleton, PA 182016835

Call 5704556385 Location details and other listings
Medical Disclaimer

This profile restates public CMS/NPPES data; T-MedInfo gives no medical advice — consult a licensed professional, and call 911 for emergencies.

Practice Location & Contact Primary Location

Practice Address

750 E Broad St

Hazleton, PA 182016835

Telephone 5704556385
Organization at the Same NPPES Address or Phone
Northeast Counseling Services Facility NPI 1366445082

Matched by practice address or phone in NPPES. A shared address or phone does not confirm that this clinician works there.

NPI first issued

2023

The year this clinician's National Provider Identifier (NPI) was issued. An NPI is a unique 10-digit ID that US health care providers use for billing.

What this does not show: NPI first issued

NPIs have been issued only since 2005, so this year is not necessarily when the clinician started practicing.

Source: CMS NPPES NPI Registry.

Medicare assignment not listed

CMS data do not show whether this clinician accepts Medicare assignment. This does not mean they do not accept Medicare. Ask the office.

Medicare assignment applies to Original Medicare. It does not tell you whether the clinician is in a Medicare Advantage plan's network, accepts other insurance, or is taking new patients.

Source: CMS Doctors and Clinicians; Medicare.gov, β€œDoes your provider accept Medicare as full payment?”

Guide: What Medicare assignment means

No telehealth indicator

CMS shows this indicator only when recent Medicare claims include telehealth services. The clinician may still offer telehealth; ask the office.

Source: CMS, Telehealth Indicator on Medicare Care Compare (fact sheet, January 2023); CMS Doctors and Clinicians.

Guide: How Medicare covers telehealth

Compared with the same specialty in Hazleton and Pennsylvania

12 active clinicians are listed under Counselor - Professional with a practice address in Hazleton, PA (9,346 in Pennsylvania).

Addresses are self-reported to NPPES and may be out of date.

Telehealth indicator in Hazleton

0% of these 12 clinicians have the CMS telehealth indicator.

25% of these 12 clinicians are listed by CMS as accepting Medicare assignment.

Sources: CMS Doctors and Clinicians, CMS NPPES NPI Registry. Specialty names follow the NUCC Health Care Provider Taxonomy.

Text: T-MedInfo Β· Report an error.

Specialties & License Numbers Reported to NPPES

Self-certified to NPPES: 2026-03-16
Counselor - Professional Primary Specialty

NUCC Taxonomy Code: 101YP2500X

License # reported to NPPES PA APC000752
Check License Status with the State Board License numbers are self-reported to NPPES; T-MedInfo does not confirm them against state records. Current status: Pennsylvania Department of State Licensing.
Look Up on State Board Site

Clinicians Sharing This Practice Address or Phone

Clinicians sharing this NPPES address, phone or fax; a shared contact does not mean they work together.

3 listed
Dr. Nilesh Baxi , MD

Psychiatry & Neurology - Psychiatry

NPI 1851322457

Doctor of Medicine (M.D.)

Dorothy Perillo , PA-C

Physician Assistant

NPI 1447336599

Physician Assistant (Certified)

Dr. Patalam Sriharsha , MD

Psychiatry & Neurology - Geriatric Psychiatry

NPI 1154377562

Doctor of Medicine (M.D.)

Career & Practice History Timeline

Changes recorded in monthly NPPES data files: addresses, names, credentials, specialties and NPI status

12 Historical Events
πŸ“
Updated Practice Location March 16, 2026

Registered at 750 E BROAD ST, HAZLETON, PA 182016835 (Tel: 5704556385)

πŸ“
Updated Business Mailing Address March 16, 2026

Registered at 4 RITTENHOUSE PL, DRUMS, PA 182222744

πŸ“
Updated Practice Location March 25, 2025

Registered at 706 BLOOM RD, DANVILLE, PA 178211367 (Tel: 5702594388)

πŸ“
Updated Business Mailing Address March 25, 2025

Registered at 706 BLOOM RD, DANVILLE, PA 178211367 (Tel: 5702594388)

πŸ‘€
Provider Name / Credentials Updated March 25, 2025

Recorded as GENESIS ROQUE, MS, LAPC

πŸŽ“
Medical Taxonomy / Specialty Registered (Primary Specialty) March 25, 2025

Counselor (license number reported to NPPES: PA APC000752)

βœ…
NPI Profile Active June 27, 2023

NPI status registered as active in NPPES database

πŸ“
Business Mailing Address (Initial Record) June 27, 2023

Registered at 307 LAIRD ST, WILKES BARRE, PA 187026915

πŸ“
Practice Location (Initial Record) June 27, 2023

Registered at 307 LAIRD ST, WILKES BARRE, PA 187026915 (Tel: 5704097880)

πŸ‘€
Provider Name / Credentials (Initial Record) June 27, 2023

Recorded as GENESIS ROQUE, MS

πŸŽ“
Medical Taxonomy / Specialty Registered (Primary Specialty) June 27, 2023

Counselor

🟒
Initial NPI Registration & Enumeration June 27, 2023

First registered as active Individual Practitioner in NPPES Database.

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NPI Administrative Meta

NPI Number: 1659057370
Entity Type:
Individual Provider Physician, Nurse Practitioner, or Solo Healthcare Professional (Type 1 NPI)
Enumeration Date: June 27, 2023
Last Update: March 16, 2026
Sole Proprietor: Yes

Mailing Address

4 Rittenhouse Pl

Drums, PA 182222744

About This Data NPPES fields (address, phone, specialty, license) are self-reported and may be outdated; Medicare fields follow the CMS dataset named in each section. Correct directly at NPPES.