MEDICARE: PAUL DERENZO LMHCA

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	101YM0800X	Mental Health Counselor	MHC.LH.70024967	WA

General Provider Information

NPI Number	:	1477308138
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PAUL DERENZO LMHCA

Provider Business Mailing Address
First Line	:	2653 HUNTERS POINT DR
Second Line	:
City	:	WEXFORD
State	:	PA
Zip	:	15090-7992
Country	:	US
Telephone Number	:	412-496-1420
Fax Number	:

Provider Business Practice Location Address
First Line	:	100 N HOWARD ST STE W
Second Line	:
City	:	SPOKANE
State	:	WA
Zip	:	99201-0508
Country	:	US
Telephone Number	:	206-348-4671
Fax Number	:

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

Provider Enumeration Date	:	04/17/2024
Last Update Date	:	01/26/2026

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