Healthcare Provider Details

I. General information

NPI: 1821626763
Provider Name (Legal Business Name): RENEWAL INTEGRATIVE PSYCHOTHERAPIES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/27/2020
Last Update Date: 05/06/2024
Certification Date: 05/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

90 MADISON ST STE 502
WORCESTER MA
01608-2058
US

IV. Provider business mailing address

90 MADISON ST STE 502
WORCESTER MA
01608-2058
US

V. Phone/Fax

Practice location:
  • Phone: 774-530-6940
  • Fax: 774-530-6941
Mailing address:
  • Phone: 774-530-6940
  • Fax: 774-530-6941

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QC1800X
TaxonomyCorporate Health Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MS. MARCIA AMARSINGH
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 774-530-6363