Provider Demographics
NPI:1770235830
Name:RENEW CONCIERGE PSYCHOTHERAPY LCSW PLLC
Entity Type:Organization
Organization Name:RENEW CONCIERGE PSYCHOTHERAPY LCSW PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:O. KEELEY
Authorized Official - Middle Name:
Authorized Official - Last Name:TEEMSMA
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:646-389-7489
Mailing Address - Street 1:159 20TH ST STE 1B
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11232-1254
Mailing Address - Country:US
Mailing Address - Phone:646-389-7489
Mailing Address - Fax:
Practice Address - Street 1:14 WALL ST FL 20
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10005-2123
Practice Address - Country:US
Practice Address - Phone:646-389-7489
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-20
Last Update Date:2022-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health