Provider Demographics
NPI:1518203793
Name:CHUNG, RENAE K (PHD)
Entity Type:Individual
Prefix:DR
First Name:RENAE
Middle Name:K
Last Name:CHUNG
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2360 CARDINAL CT
Mailing Address - Street 2:UNIT F
Mailing Address - City:WOOSTER
Mailing Address - State:OH
Mailing Address - Zip Code:44691-2063
Mailing Address - Country:US
Mailing Address - Phone:614-607-3944
Mailing Address - Fax:
Practice Address - Street 1:2200 W BROAD ST
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43223-1297
Practice Address - Country:US
Practice Address - Phone:614-752-0333
Practice Address - Fax:614-272-7227
Is Sole Proprietor?:No
Enumeration Date:2012-12-17
Last Update Date:2019-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH6823103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical