Healthcare Provider Details

I. General information

NPI: 1881051118
Provider Name (Legal Business Name): MS. RENE DENISE WHITEHURST
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/18/2016
Last Update Date: 01/18/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

521 W 239TH ST 4L
BRONX NY
10463-1205
US

IV. Provider business mailing address

521 W 239TH ST 4L
BRONX NY
10463-1205
US

V. Phone/Fax

Practice location:
  • Phone: 718-601-2280
  • Fax:
Mailing address:
  • Phone: 718-601-2280
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number070123
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: