Provider Demographics
NPI:1093892937
Name:RENTEL, ELAINE (MSW, LISW)
Entity Type:Individual
Prefix:
First Name:ELAINE
Middle Name:
Last Name:RENTEL
Suffix:
Gender:F
Credentials:MSW, LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3885 NORBROOK DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43220-4704
Mailing Address - Country:US
Mailing Address - Phone:614-459-0167
Mailing Address - Fax:614-459-2076
Practice Address - Street 1:1035 PROPRIETORS RD
Practice Address - Street 2:
Practice Address - City:WORTHINGTON
Practice Address - State:OH
Practice Address - Zip Code:43085-3230
Practice Address - Country:US
Practice Address - Phone:614-785-1115
Practice Address - Fax:614-785-0095
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI-00013961041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
052590OtherVALUE OPTIONS
4564245OtherAETNA
000000120814OtherANTHEM
052590OtherVALUE OPTIONS