1841367166 NPI number — J. DAVID RENOUF LCMHC

Table of content: J. DAVID RENOUF LCMHC (NPI 1841367166)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1841367166 NPI number — J. DAVID RENOUF LCMHC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RENOUF
Provider First Name:
J. DAVID
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LCMHC
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
RENOUF
Provider Other First Name:
JOHN
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1841367166
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/14/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
250 COMMERCIAL STREET
Provider Second Line Business Mailing Address:
SUITE 3004
Provider Business Mailing Address City Name:
MANCHESTER
Provider Business Mailing Address State Name:
NH
Provider Business Mailing Address Postal Code:
03101-1118
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
603-668-3050
Provider Business Mailing Address Fax Number:
603-668-8666

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
250 COMMERCIAL STREET
Provider Second Line Business Practice Location Address:
SUITE 3004
Provider Business Practice Location Address City Name:
MANCHESTER
Provider Business Practice Location Address State Name:
NH
Provider Business Practice Location Address Postal Code:
03101-1118
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
603-668-3050
Provider Business Practice Location Address Fax Number:
603-668-8666
Provider Enumeration Date:
11/30/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X , with the licence number:  167 , registered in the state of NH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1406518Y0NH01 . This is a "BLUE CROSS" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".
  • Identifier: 1039158 . This is a "CIGNA" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".
  • Identifier: 3076144 , issued by the state of ( NH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 020258994-74 . This is a "HARVARD PILGRIM" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".




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