MEDICARE: RENITA CHRISTEL ALLEN LISW-S

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	1041C0700X	Clinical Social Worker	I.0001942	OH

General Provider Information

NPI Number	:	1164606547
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RENITA CHRISTEL ALLEN LISW-S

Provider Business Mailing Address
First Line	:	21407 RAYMOND ST
Second Line	:
City	:	MAPLE HEIGHTS
State	:	OH
Zip	:	44137-2154
Country	:	US
Telephone Number	:	216-475-6305
Fax Number	:

Provider Business Practice Location Address
First Line	:	21407 RAYMOND ST
Second Line	:
City	:	MAPLE HEIGHTS
State	:	OH
Zip	:	44137-2154
Country	:	US
Telephone Number	:	216-475-6305
Fax Number	:

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

Provider Enumeration Date	:	12/20/2007
Last Update Date	:	01/23/2020

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