Provider Demographics
NPI:1861028474
Name:RENZI, MARCO JOLLY
Entity Type:Individual
Prefix:
First Name:MARCO
Middle Name:JOLLY
Last Name:RENZI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:820 N ORLEANS ST STE 350
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60610-3145
Mailing Address - Country:US
Mailing Address - Phone:312-809-0298
Mailing Address - Fax:
Practice Address - Street 1:820 N ORLEANS ST STE 350
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60610-3145
Practice Address - Country:US
Practice Address - Phone:312-809-0298
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-15
Last Update Date:2023-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490246211041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical