Healthcare Provider Details

I. General information

NPI: 1427347624
Provider Name (Legal Business Name): MICHAEL PAUL RENO LMHC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/29/2011
Last Update Date: 05/05/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 CEDAR ST
WORCESTER MA
01609-2520
US

IV. Provider business mailing address

20 CEDAR ST
WORCESTER MA
01609-2520
US

V. Phone/Fax

Practice location:
  • Phone: 508-753-5425
  • Fax: 508-753-9625
Mailing address:
  • Phone: 508-753-5425
  • Fax: 508-753-9625

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number6043
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: