MEDICARE: RENAE KENDRICK BSW

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	104100000X	Social Worker	104100000	FL

General Provider Information

NPI Number	:	1912369083
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RENAE KENDRICK BSW

Provider Business Mailing Address
First Line	:	5906 E 122ND AVE
Second Line	:	109
City	:	TAMPA
State	:	FL
Zip	:	33617-1617
Country	:	US
Telephone Number	:	813-900-7941
Fax Number	:

Provider Business Practice Location Address
First Line	:	5906 E 122ND AVE
Second Line	:	109
City	:	TAMPA
State	:	FL
Zip	:	33617-1617
Country	:	US
Telephone Number	:	813-900-7941
Fax Number	:

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

Provider Enumeration Date	:	03/28/2016
Last Update Date	:	03/28/2016

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Directions to “ RENAE KENDRICK BSW” Practice Location

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