Provider Demographics
NPI:1821626763
Name:RENEWAL INTEGRATIVE PSYCHOTHERAPIES LLC
Entity Type:Organization
Organization Name:RENEWAL INTEGRATIVE PSYCHOTHERAPIES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:MARCIA
Authorized Official - Middle Name:
Authorized Official - Last Name:AMARSINGH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:774-530-6363
Mailing Address - Street 1:90 MADISON ST STE 502
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01608-2058
Mailing Address - Country:US
Mailing Address - Phone:774-530-6940
Mailing Address - Fax:774-530-6941
Practice Address - Street 1:90 MADISON ST STE 502
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01608-2058
Practice Address - Country:US
Practice Address - Phone:774-530-6940
Practice Address - Fax:774-530-6941
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-27
Last Update Date:2021-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC1800XAmbulatory Health Care FacilitiesClinic/CenterCorporate Health
No261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service