Healthcare Provider Details

I. General information

NPI: 1982205704
Provider Name (Legal Business Name): RENAISSANCE CLINICAL SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/06/2020
Last Update Date: 11/17/2020
Certification Date: 11/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4495 HALE PKWY STE 114
DENVER CO
80220-6203
US

IV. Provider business mailing address

1044 MILWAUKEE ST
DENVER CO
80206-3338
US

V. Phone/Fax

Practice location:
  • Phone: 303-523-3698
  • Fax:
Mailing address:
  • Phone: 303-523-3698
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: MR. RENEE VERONICA RIVERA
Title or Position: OWNER/PSYCHOTHERAPIST
Credential: LCSW
Phone: 303-523-3698