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General NPI Number Information
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NPI Number | 1457978991
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Entity Type | Organization
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Legal Business Name | RENEW PSYCHIATRIC CARE, LLC
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Dates
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Enumeration Date | 07/01/2020
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Last Update Date | 09/17/2020
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Provider Practice Location Address
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Address Line | 3170 N FEDERAL HWY STE 206B
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City | LIGHTHOUSE POINT
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State | FL
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Zip | 33064-6720
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Country | US
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Telephone | 954-522-5100
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Fax |
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Provider Business Mailing Address
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Address Line | 3170 N FEDERAL HWY STE 206B
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City | LIGHTHOUSE POINT
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State | FL
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Zip | 33064-6720
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | GENERAL PARTNER
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Name | SCOTT SNADER
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Credential |
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Telephone | 954-552-5100
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103G00000X
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Taxonomy Name | Clinical Neuropsychologist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 133V00000X
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Taxonomy Name | Registered Dietitian
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 207QA0505X
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Taxonomy Name | Adult Medicine Physician
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 2084A0401X
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Taxonomy Name | Addiction Medicine (Psychiatry & Neurology) Physician
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 103TB0200X
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Taxonomy Name | Cognitive & Behavioral Psychologist
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License Number |
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License Number State |
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