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General NPI Number Information
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NPI Number | 1649729021
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Entity Type | Organization
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Legal Business Name | RENAISSANCE PRIMARY CARE, LLC
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Dates
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Enumeration Date | 09/27/2016
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Last Update Date | 07/15/2025
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Provider Practice Location Address
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Address Line | 11-15 SANDERSDALE ROAD
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City | SOUTHBRIDGE
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State | MA
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Zip | 01550
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Country | US
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Telephone | 774-420-2311
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Fax | 508-519-0763
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Provider Business Mailing Address
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Address Line | 11-15 SANDERSDALE ROAD
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City | SOUTHBRIDGE
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State | MA
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Zip | 01550
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Country | US
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Telephone | 774-420-2311
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Fax | 508-519-0763
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Authorized Official
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Title or Position | PSYCHOLOGIST
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Name | DR. JAMES MANUEL
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Credential | PSYCHOLOGIST
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Telephone | 774-420-2311
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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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 | 103T00000X
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Taxonomy Name | Psychologist
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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 | 2084P0800X
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Taxonomy Name | Psychiatry 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 | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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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 | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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