Provider Demographics
NPI:1073623484
Name:RENARD, ROBERT NORMAN (LCSW)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:NORMAN
Last Name:RENARD
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1056 E META ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93001-3094
Mailing Address - Country:US
Mailing Address - Phone:805-643-3061
Mailing Address - Fax:805-643-3061
Practice Address - Street 1:1056 E META ST
Practice Address - Street 2:SUITE 201
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93001-3094
Practice Address - Country:US
Practice Address - Phone:805-643-3061
Practice Address - Fax:805-643-3061
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2012-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS108611041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACSW108610Medicaid
CALCS 10861OtherSTATE OF CALIFORNIA LIC.
CASW10861AMedicare ID - Type UnspecifiedMEDICARE NUMBER