Provider Demographics
NPI:1225407414
Name:RENNA, KEVIN
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:
Last Name:RENNA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41 MASON ST
Mailing Address - Street 2:UNIT 1
Mailing Address - City:SALEM
Mailing Address - State:MA
Mailing Address - Zip Code:01970-2260
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:41 MASON ST
Practice Address - Street 2:UNIT 1
Practice Address - City:SALEM
Practice Address - State:MA
Practice Address - Zip Code:01970-2260
Practice Address - Country:US
Practice Address - Phone:978-745-2440
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-18
Last Update Date:2015-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health