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1376606921 NPI number — RENYALE TREON DAVIS LCSW

NPI Number: 1376606921
Health Care Provider/Practitioner: RENYALE TREON DAVIS LCSW

Information about “1376606921” NPI (RENYALE TREON DAVIS LCSW) exists in 1376606921 in HTML format HTML  |  1376606921 in plain Text format TXT  |  1376606921 in PDF (Portable Document Format) PDF  |  1376606921 in an XML format XML  formats.

NPI Number : 1376606921 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1376606921",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "DAVIS",
    "FirstName": "RENYALE",
    "MiddleName": "TREON",
    "NamePrefix": "MRS.",
    "NameSuffix": null,
    "Credential": "LCSW",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "COTTON",
    "OtherFirstName": "RENYALE",
    "OtherMiddleName": "TREON",
    "OtherNamePrefix": "MS.",
    "OtherNameSuffix": null,
    "OtherCredential": "LCSW",
    "OtherLastNameTypeCode": "2",
    "FirstLineMailingAddress": "6240 W OAKLAND PARK BLVD UNIT 190636",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "LAUDERHILL",
    "MailingAddressStateName": "FL",
    "MailingAddressPostalCode": "33319-8725",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "754-238-6079",
    "MailingAddressFaxNumber": "--",
    "FirstLinePracticeLocationAddress": "8400 N UNIVERSITY DRIVE 219",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "TAMARAC",
    "PracticeLocationAddressStateName": "FL",
    "PracticeLocationAddressPostalCode": "33321",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "754-238-6079",
    "PracticeLocationAddressFaxNumber": "--",
    "EnumerationDate": "12/18/2006",
    "LastUpdateDate": "12/06/2022",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "F",
    "Gender": "Female",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "1041C0700X",
        "TaxonomyName": "Clinical Social Worker",
        "LicenseNumber": "SW8214",
        "LicenseNumberStateCode": "FL",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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