Provider Demographics
NPI:1417654344
Name:RENEW OUTPATIENT COUNSELING LLC
Entity Type:Organization
Organization Name:RENEW OUTPATIENT COUNSELING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BAYLEE
Authorized Official - Middle Name:
Authorized Official - Last Name:STONE
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:978-758-6725
Mailing Address - Street 1:33 CIRCUIT AVE
Mailing Address - Street 2:
Mailing Address - City:POCASSET
Mailing Address - State:MA
Mailing Address - Zip Code:02559-2024
Mailing Address - Country:US
Mailing Address - Phone:978-758-6725
Mailing Address - Fax:
Practice Address - Street 1:33 CIRCUIT AVE
Practice Address - Street 2:
Practice Address - City:POCASSET
Practice Address - State:MA
Practice Address - Zip Code:02559-2024
Practice Address - Country:US
Practice Address - Phone:978-758-6725
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-10
Last Update Date:2023-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health