Provider Demographics
NPI:1497451769
Name:RENEW COUNSELING PRACTICING LICENSED CLINICAL SOCIAL WORK PLLC
Entity Type:Organization
Organization Name:RENEW COUNSELING PRACTICING LICENSED CLINICAL SOCIAL WORK PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:DECAPRIA CLOSE
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW-R
Authorized Official - Phone:607-654-4450
Mailing Address - Street 1:8 DENISON PKWY E STE 305
Mailing Address - Street 2:
Mailing Address - City:CORNING
Mailing Address - State:NY
Mailing Address - Zip Code:14830-2644
Mailing Address - Country:US
Mailing Address - Phone:607-654-4450
Mailing Address - Fax:
Practice Address - Street 1:8 DENISON PKWY E STE 305
Practice Address - Street 2:
Practice Address - City:CORNING
Practice Address - State:NY
Practice Address - Zip Code:14830-2644
Practice Address - Country:US
Practice Address - Phone:607-654-4450
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-07
Last Update Date:2023-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty