Provider Demographics
NPI:1851550636
Name:RENAUD, EDWIN (LCSW PHD)
Entity Type:Individual
Prefix:MR
First Name:EDWIN
Middle Name:
Last Name:RENAUD
Suffix:
Gender:M
Credentials:LCSW PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 ORANGE STREET
Mailing Address - Street 2:ALSO-CORNERSTONE INC
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06510-2014
Mailing Address - Country:US
Mailing Address - Phone:203-787-2111
Mailing Address - Fax:203-397-9077
Practice Address - Street 1:205 ORANGE ST
Practice Address - Street 2:
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06510-2069
Practice Address - Country:US
Practice Address - Phone:203-787-2111
Practice Address - Fax:203-397-9077
Is Sole Proprietor?:No
Enumeration Date:2008-06-05
Last Update Date:2008-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0043161041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004212148Medicaid
CTCTGA000525OtherDMHAS