Provider Demographics
NPI:1275722159
Name:RENTZ, MARJORIE L (LISW)
Entity Type:Individual
Prefix:
First Name:MARJORIE
Middle Name:L
Last Name:RENTZ
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 OREGONIA RD FL 2
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:OH
Mailing Address - Zip Code:45036-3903
Mailing Address - Country:US
Mailing Address - Phone:513-695-2411
Mailing Address - Fax:513-695-2309
Practice Address - Street 1:107 OREGONIA RD FL 2
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:OH
Practice Address - Zip Code:45036-3903
Practice Address - Country:US
Practice Address - Phone:513-695-2411
Practice Address - Fax:513-695-2309
Is Sole Proprietor?:No
Enumeration Date:2007-10-17
Last Update Date:2007-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI-102141041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical