MEDICARE: RENACER COUNSELING LLC

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	261Q00000X	Clinic/Center

General Provider Information

NPI Number	:	1619869435
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RENACER COUNSELING LLC

Provider Business Mailing Address
First Line	:	1740 BOCA CHICA BLVD STE 200
Second Line	:
City	:	BROWNSVILLE
State	:	TX
Zip	:	78520-8132
Country	:	US
Telephone Number	:	956-346-0418
Fax Number	:

Provider Business Practice Location Address
First Line	:	1740 BOCA CHICA BLVD STE 200A
Second Line	:
City	:	BROWNSVILLE
State	:	TX
Zip	:	78520-8132
Country	:	US
Telephone Number	:	956-346-0418
Fax Number	:

Authorized Official
Title or Position	:	OWNER / CLINICAL DIRECTOR
Name	:	ROXANA CASIANO MALDONADO
Credential	:	LPC
Telephone Number	:	956-346-0418

Provider Enumeration Date	:	07/16/2025
Last Update Date	:	07/16/2025

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