MEDICARE: RENAE SEVER PHD

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
1	101YP2500X	Professional Counselor	APC000225	PA

General Provider Information

NPI Number	:	1134959133
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RENAE SEVER PHD

Provider Business Mailing Address
First Line	:	115 BLUEBIRD RD
Second Line	:
City	:	WEST NEWTON
State	:	PA
Zip	:	15089-9509
Country	:	US
Telephone Number	:	724-797-4287
Fax Number	:

Provider Business Practice Location Address
First Line	:	115 BLUEBIRD RD
Second Line	:
City	:	WEST NEWTON
State	:	PA
Zip	:	15089-9509
Country	:	US
Telephone Number	:	724-797-4287
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/05/2024
Last Update Date	:	08/05/2024

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