Provider Demographics
NPI:1578634622
Name:RENZONI, MARLA B (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:MARLA
Middle Name:B
Last Name:RENZONI
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 ZABRISKIE TER
Mailing Address - Street 2:
Mailing Address - City:MONSEY
Mailing Address - State:NY
Mailing Address - Zip Code:10952-1953
Mailing Address - Country:US
Mailing Address - Phone:845-323-9450
Mailing Address - Fax:845-290-1234
Practice Address - Street 1:11 ZABRISKIE TER
Practice Address - Street 2:
Practice Address - City:MONSEY
Practice Address - State:NY
Practice Address - Zip Code:10952-1953
Practice Address - Country:US
Practice Address - Phone:845-323-9450
Practice Address - Fax:845-290-1234
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY071958101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health