MEDICARE: MRS. PATTI LYNN RENKO MSW, LCSW-C

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	08164	MD

General Provider Information

NPI Number	:	1578825154
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. PATTI LYNN RENKO MSW, LCSW-C

Provider Business Mailing Address
First Line	:	5117 CRESTWOOD LN
Second Line	:
City	:	ELLICOTT CITY
State	:	MD
Zip	:	21043-7051
Country	:	US
Telephone Number	:	410-627-4899
Fax Number	:

Provider Business Practice Location Address
First Line	:	5117 CRESTWOOD LN
Second Line	:
City	:	ELLICOTT CITY
State	:	MD
Zip	:	21043-7051
Country	:	US
Telephone Number	:	410-627-4899
Fax Number	:

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

Provider Enumeration Date	:	06/11/2012
Last Update Date	:	02/06/2013

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