Provider Demographics
NPI:1376606921
Name:DAVIS, RENYALE TREON (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:RENYALE
Middle Name:TREON
Last Name:DAVIS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:RENYALE
Other - Middle Name:TREON
Other - Last Name:COTTON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:6240 W OAKLAND PARK BLVD UNIT 190636
Mailing Address - Street 2:
Mailing Address - City:LAUDERHILL
Mailing Address - State:FL
Mailing Address - Zip Code:33319-8725
Mailing Address - Country:US
Mailing Address - Phone:754-238-6079
Mailing Address - Fax:000-000-0000
Practice Address - Street 1:8400 N UNIVERSITY DRIVE 219
Practice Address - Street 2:
Practice Address - City:TAMARAC
Practice Address - State:FL
Practice Address - Zip Code:33321
Practice Address - Country:US
Practice Address - Phone:754-238-6079
Practice Address - Fax:000-000-0000
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-18
Last Update Date:2022-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW82141041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL767771500Medicaid