Healthcare Provider Details

I. General information

NPI: 1013324011
Provider Name (Legal Business Name): EMILY RENNARD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/22/2014
Last Update Date: 01/11/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

112 MARKET ST
LYNN MA
01901
US

IV. Provider business mailing address

112 MARKET ST SECOND FLOOR, CHILDREN'S FRIEND AND FAMILY SERVICES
LYNN MA
01901
US

V. Phone/Fax

Practice location:
  • Phone: 781-691-7665
  • Fax:
Mailing address:
  • Phone: 781-691-7665
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: