Provider Demographics
NPI:1316542921
Name:RENEAU, LAVICIA (BIRTH DOULA)
Entity Type:Individual
Prefix:
First Name:LAVICIA
Middle Name:
Last Name:RENEAU
Suffix:
Gender:F
Credentials:BIRTH DOULA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:245 5TH AVE STE 316
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016-8728
Mailing Address - Country:US
Mailing Address - Phone:929-288-3379
Mailing Address - Fax:
Practice Address - Street 1:245 5TH AVE STE 316
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-8728
Practice Address - Country:US
Practice Address - Phone:929-288-3379
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-01
Last Update Date:2020-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula