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General NPI Number Information
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NPI Number | 1639088073
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Entity Type | Organization
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Legal Business Name | RENEW360 PROFESSIONAL GROUP, LLC
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Dates
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Enumeration Date | 09/02/2026
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Last Update Date | 09/02/2026
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Provider Practice Location Address
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Address Line | 1181 ROUTE 37 WEST
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City | TOMS RIVER
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State | NJ
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Zip | 08755-4919
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Country | US
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Telephone | 732-234-0058
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Fax |
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Provider Business Mailing Address
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Address Line | 1181 ROUTE 37 WEST
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City | TOMS RIVER
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State | NJ
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Zip | 08755-4919
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Country | US
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Telephone | 732-234-0058
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Fax |
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Authorized Official
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Title or Position | CLINICAL DIRECTOR
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Name | MS. ADREYANNA HARVEY
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Credential | LPC
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Telephone | 732-234-0058
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RA0401X
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Taxonomy Name | Addiction Medicine (Internal Medicine) Physician
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License Number |
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License Number State |
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