Healthcare Provider Details

I. General information

NPI: 1447317458
Provider Name (Legal Business Name): BRIAN RENARD MSW, L.I.C.S.W.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/02/2007
Last Update Date: 02/19/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

60 PERSEVERANCE WAY
HYANNIS MA
02601-1843
US

IV. Provider business mailing address

PO BOX 79
TRURO MA
02666-0079
US

V. Phone/Fax

Practice location:
  • Phone: 508-224-8041
  • Fax:
Mailing address:
  • Phone: 508-487-6239
  • 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:
Title or Position:
Credential:
Phone: