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NPI Code Detail

MEDICARE: MR. DEREK MARTIN RENKO LMSW

MEDICARE: MR. DEREK MARTIN RENKO LMSW
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11041C0700XClinical Social Worker18869SC

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1053039438
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. DEREK MARTIN RENKO LMSW
Provider Business Mailing Address
First Line : 2100 CHARLIE HALL BLVD
Second Line :
City : CHARLESTON
State : SC
Zip : 29414-5832
Country : US
Telephone Number : 843-852-4100
Fax Number :
Provider Business Practice Location Address
First Line : 2100 CHARLIE HALL BLVD
Second Line :
City : CHARLESTON
State : SC
Zip : 29414-5832
Country : US
Telephone Number : 843-852-4100
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/22/2022
Last Update Date : 06/08/2026

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