Provider Demographics
NPI:1760043905
Name:RENEW BEHAVIORAL HEALTH AND WELLNESS
Entity Type:Organization
Organization Name:RENEW BEHAVIORAL HEALTH AND WELLNESS
Other - Org Name:RENEW BHW
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GRACE
Authorized Official - Middle Name:
Authorized Official - Last Name:TERRAZAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:781-330-1441
Mailing Address - Street 1:11 BELLEVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:MARLBOROUGH
Mailing Address - State:MA
Mailing Address - Zip Code:01752-1201
Mailing Address - Country:US
Mailing Address - Phone:781-330-1441
Mailing Address - Fax:
Practice Address - Street 1:7O BOSTON POST RD
Practice Address - Street 2:SUITE R3
Practice Address - City:WAYLAND
Practice Address - State:MA
Practice Address - Zip Code:01778
Practice Address - Country:US
Practice Address - Phone:781-330-1441
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-27
Last Update Date:2022-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty