Provider Demographics
NPI:1013554997
Name:RENOV, BETH ELANA (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:BETH
Middle Name:ELANA
Last Name:RENOV
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:232 PAVONIA AVE APT 511
Mailing Address - Street 2:
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07302-1759
Mailing Address - Country:US
Mailing Address - Phone:201-407-8951
Mailing Address - Fax:
Practice Address - Street 1:201 MONTGOMERY STREET, SECOND FLOOR
Practice Address - Street 2:OFFICE 2024
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07302-5052
Practice Address - Country:US
Practice Address - Phone:201-890-5370
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-10
Last Update Date:2019-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC058535001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical