Provider Demographics
NPI:1538660501
Name:DENOME, RITA (LMSW)
Entity Type:Individual
Prefix:
First Name:RITA
Middle Name:
Last Name:DENOME
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2301 IDLEWOOD RD
Mailing Address - Street 2:
Mailing Address - City:JEFFERSON CITY
Mailing Address - State:MO
Mailing Address - Zip Code:65109-2119
Mailing Address - Country:US
Mailing Address - Phone:573-418-1677
Mailing Address - Fax:
Practice Address - Street 1:2301 IDLEWOOD RD
Practice Address - Street 2:
Practice Address - City:JEFFERSON CITY
Practice Address - State:MO
Practice Address - Zip Code:65109-2119
Practice Address - Country:US
Practice Address - Phone:573-418-1677
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-26
Last Update Date:2021-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010914811041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical