MEDICARE: RENEA DENISE ROYAL MSW, LMSW, ACSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	6801074252	MI
2	1041C0700X	Clinical Social Worker	9798C	NV

General Provider Information

NPI Number	:	1497072417
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RENEA DENISE ROYAL MSW, LMSW, ACSW

Provider Business Mailing Address
First Line	:	3250 S TOWN CENTER DR UNIT 2028
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89135-2253
Country	:	US
Telephone Number	:	248-943-9923
Fax Number	:

Provider Business Practice Location Address
First Line	:	3250 S TOWN CENTER DR UNIT 2028
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89135-2253
Country	:	US
Telephone Number	:	248-943-9923
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/29/2010
Last Update Date	:	08/05/2024

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