Provider Demographics
NPI:1043935976
Name:ALDRICH, RENU
Entity Type:Individual
Prefix:
First Name:RENU
Middle Name:
Last Name:ALDRICH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7922 DENTON DR
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:MD
Mailing Address - Zip Code:20735-2039
Mailing Address - Country:US
Mailing Address - Phone:914-819-2765
Mailing Address - Fax:
Practice Address - Street 1:1501 LEE HWY STE 102
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22209-1109
Practice Address - Country:US
Practice Address - Phone:703-909-5101
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-04
Last Update Date:2022-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001119106H00000X
MDLCM892106H00000X
VA0717001552106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist