Provider Demographics
NPI:1518375898
Name:JOHN LOUIS RENZULLI
Entity Type:Organization
Organization Name:JOHN LOUIS RENZULLI
Other - Org Name:FAMILY PSYCHOTHERAPY & CONSULTING
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:LOUIS
Authorized Official - Last Name:RENZULLI
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:203-405-1186
Mailing Address - Street 1:PO BOX 1334
Mailing Address - Street 2:
Mailing Address - City:SOUTHBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06488-8334
Mailing Address - Country:US
Mailing Address - Phone:203-405-1186
Mailing Address - Fax:
Practice Address - Street 1:43 SHERMAN HILL RD
Practice Address - Street 2:BUILDING D, SUITE 103
Practice Address - City:WOODBURY
Practice Address - State:CT
Practice Address - Zip Code:06798-3651
Practice Address - Country:US
Practice Address - Phone:203-405-1186
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-30
Last Update Date:2014-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT27701041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty