Provider Demographics
NPI:1689283194
Name:RENEE NATVIG, LLC
Entity Type:Organization
Organization Name:RENEE NATVIG, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:RENEE
Authorized Official - Middle Name:
Authorized Official - Last Name:NATVIG
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:407-625-3134
Mailing Address - Street 1:1644 E RIDGEWOOD ST
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32803-5539
Mailing Address - Country:US
Mailing Address - Phone:407-625-3134
Mailing Address - Fax:
Practice Address - Street 1:631 N HYER AVE
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32803-4629
Practice Address - Country:US
Practice Address - Phone:407-625-3134
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-30
Last Update Date:2020-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty