MEDICARE: RENEE TAYLOR HAINES MSW, LISW-S

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	I. 1200996 . SUPV	OH

General Provider Information

NPI Number	:	1871951285
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RENEE TAYLOR HAINES MSW, LISW-S

Provider Business Mailing Address
First Line	:	5783 KATARA DR
Second Line	:
City	:	GALLOWAY
State	:	OH
Zip	:	43119-8113
Country	:	US
Telephone Number	:	614-204-9446
Fax Number	:

Provider Business Practice Location Address
First Line	:	2865 W BROAD ST
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43204-2643
Country	:	US
Telephone Number	:	614-230-3481
Fax Number	:

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

Provider Enumeration Date	:	02/01/2016
Last Update Date	:	02/01/2016

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