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General NPI Number Information
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NPI Number | 1376082610
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Entity Type | Organization
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Legal Business Name | RENEW WELLNESS & PSYCHOTHERAPY, LLC
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Dates
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Enumeration Date | 02/20/2017
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Last Update Date | 03/03/2022
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Provider Practice Location Address
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Address Line | 641 N 13TH ST STE E-101
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City | EASTON
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State | PA
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Zip | 18042-1430
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Country | US
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Telephone | 484-725-0072
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Fax |
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Provider Business Mailing Address
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Address Line | 215 W. LAFAYETTE ST
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City | EASTON
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State | PA
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Zip | 18042
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Country | US
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Telephone | 484-725-0072
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Fax |
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Authorized Official
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Title or Position | PARTNER
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Name | MR. JONATHAN SIMON ASAYAG
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Credential | LCSW, ACSW, CAADC
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Telephone | 484-725-0072
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number |
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License Number State |
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