MEDICARE: MS. MICHELLE LESLIE RENNERT MSW, LCSW

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	44SC01371300	NJ

General Provider Information

NPI Number	:	1376873422
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MICHELLE LESLIE RENNERT MSW, LCSW

Provider Business Mailing Address
First Line	:	3307 CLEVELAND LN
Second Line	:
City	:	ROCKAWAY
State	:	NJ
Zip	:	07866-5808
Country	:	US
Telephone Number	:	973-784-3988
Fax Number	:	973-705-3862

Provider Business Practice Location Address
First Line	:	3307 CLEVELAND LN
Second Line	:
City	:	ROCKAWAY
State	:	NJ
Zip	:	07866-5808
Country	:	US
Telephone Number	:	973-784-3988
Fax Number	:	973-705-3862

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

Provider Enumeration Date	:	01/12/2010
Last Update Date	:	01/12/2010

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