Provider Demographics
NPI:1376137224
Name:RENNER, MELISSA
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:
Last Name:RENNER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:422 FRANKLIN CT
Mailing Address - Street 2:
Mailing Address - City:TRAPPE
Mailing Address - State:PA
Mailing Address - Zip Code:19426-2245
Mailing Address - Country:US
Mailing Address - Phone:610-291-7755
Mailing Address - Fax:
Practice Address - Street 1:500 OFFICE CENTER DR STE 100
Practice Address - Street 2:
Practice Address - City:FORT WASHINGTON
Practice Address - State:PA
Practice Address - Zip Code:19034-3234
Practice Address - Country:US
Practice Address - Phone:215-260-6555
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-22
Last Update Date:2021-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PABH003811101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health