Healthcare Provider Details

I. General information

NPI: 1558225292
Provider Name (Legal Business Name): RENEW HEALTH SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/15/2025
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

163 MAIN ST
FARMINGTON CT
06032-2964
US

IV. Provider business mailing address

210 MAPLE AVE UNIT 254
CHESHIRE CT
06410-7710
US

V. Phone/Fax

Practice location:
  • Phone: 854-867-3639
  • Fax:
Mailing address:
  • Phone: 854-867-3639
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: MARIO CIPOLLA
Title or Position: OWNER
Credential:
Phone: 854-867-3639