Provider Demographics
NPI:1376082610
Name:RENEW WELLNESS & PSYCHOTHERAPY, LLC
Entity Type:Organization
Organization Name:RENEW WELLNESS & PSYCHOTHERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:SIMON
Authorized Official - Last Name:ASAYAG
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW, ACSW, CAADC
Authorized Official - Phone:484-725-0072
Mailing Address - Street 1:215 W. LAFAYETTE ST
Mailing Address - Street 2:
Mailing Address - City:EASTON
Mailing Address - State:PA
Mailing Address - Zip Code:18042
Mailing Address - Country:US
Mailing Address - Phone:484-725-0072
Mailing Address - Fax:
Practice Address - Street 1:641 N 13TH ST STE E-101
Practice Address - Street 2:
Practice Address - City:EASTON
Practice Address - State:PA
Practice Address - Zip Code:18042-1430
Practice Address - Country:US
Practice Address - Phone:484-725-0072
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-20
Last Update Date:2022-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty