Healthcare Provider Details

I. General information

NPI: 1235040460
Provider Name (Legal Business Name): RENEGADE THERAPEUTICS PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/16/2026
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2901 CLINT MOORE RD
BOCA RATON FL
33496-2041
US

IV. Provider business mailing address

2901 CLINT MOORE RD 2-1001
BOCA RATON FL
33496-2041
US

V. Phone/Fax

Practice location:
  • Phone: 954-870-0475
  • Fax:
Mailing address:
  • Phone: 954-870-0475
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name: DR. ANDREA CUVA
Title or Position: PROVIDER
Credential: PH.D., LMFT
Phone: 954-870-0475