Provider Demographics
NPI:1528383601
Name:RENOV, KAREN (PHD)
Entity Type:Individual
Prefix:DR
First Name:KAREN
Middle Name:
Last Name:RENOV
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 1:156 BEACH 9TH STREET
Mailing Address - Street 2:SUITE C
Mailing Address - City:FAR ROCKAWAY
Mailing Address - State:NY
Mailing Address - Zip Code:11691-5636
Mailing Address - Country:US
Mailing Address - Phone:718-686-3149
Mailing Address - Fax:347-695-9701
Practice Address - Street 1:156 BEACH 9TH STREET
Practice Address - Street 2:SUITE C
Practice Address - City:FAR ROCKAWAY
Practice Address - State:NY
Practice Address - Zip Code:11691-5636
Practice Address - Country:US
Practice Address - Phone:718-686-3149
Practice Address - Fax:347-695-9701
Is Sole Proprietor?:No
Enumeration Date:2010-04-01
Last Update Date:2017-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYP92161103T00000X
NY021627103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist