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NPI Code Detail

MEDICARE: MRS. JENNIFER MARIE RENAUD LICSW

MEDICARE: MRS. JENNIFER MARIE RENAUD LICSW
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
1104100000XSocial Worker214311MA
21041C0700XClinical Social Worker115360MA

General Provider Information

NPI Number : 1619153558
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. JENNIFER MARIE RENAUD LICSW
Provider Business Mailing Address
First Line : 20 CEDAR ST
Second Line :
City : WORCESTER
State : MA
Zip : 01609-2520
Country : US
Telephone Number : 508-752-5425
Fax Number : 508-753-6925
Provider Business Practice Location Address
First Line : 20 CEDAR ST
Second Line :
City : WORCESTER
State : MA
Zip : 01609-2520
Country : US
Telephone Number : 508-752-5425
Fax Number : 508-753-6925
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/10/2008
Last Update Date : 12/17/2009

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