Provider Demographics
NPI:1790146892
Name:RENOUX, MATTHEW (MSW LSW)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:
Last Name:RENOUX
Suffix:
Gender:M
Credentials:MSW LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6720 HIGHPOINT BLVD
Mailing Address - Street 2:
Mailing Address - City:LIBERTY TWP
Mailing Address - State:OH
Mailing Address - Zip Code:45011-9027
Mailing Address - Country:US
Mailing Address - Phone:719-659-6730
Mailing Address - Fax:
Practice Address - Street 1:3101 DIXIE HWY
Practice Address - Street 2:
Practice Address - City:HAMILTON
Practice Address - State:OH
Practice Address - Zip Code:45015-1653
Practice Address - Country:US
Practice Address - Phone:513-737-3400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-03-16
Last Update Date:2016-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS.15008081041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical