Provider Demographics
NPI:1164723359
Name:DIEPPA, RENAN O (LMHC)
Entity Type:Individual
Prefix:
First Name:RENAN
Middle Name:O
Last Name:DIEPPA
Suffix:
Gender:M
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4325 NW 116TH AVE
Mailing Address - Street 2:
Mailing Address - City:DORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33178-4230
Mailing Address - Country:US
Mailing Address - Phone:305-463-9259
Mailing Address - Fax:
Practice Address - Street 1:4325 NW 116TH AVE
Practice Address - Street 2:
Practice Address - City:DORAL
Practice Address - State:FL
Practice Address - Zip Code:33178-4230
Practice Address - Country:US
Practice Address - Phone:305-463-9259
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-04
Last Update Date:2010-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH10135101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health