Provider Demographics
NPI:1891389425
Name:SENGUPTA, RENITA (PSYD)
Entity Type:Individual
Prefix:DR
First Name:RENITA
Middle Name:
Last Name:SENGUPTA
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 W TREMONT AVE UNIT 510
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28203-5498
Mailing Address - Country:US
Mailing Address - Phone:704-905-9758
Mailing Address - Fax:
Practice Address - Street 1:9201 UNIVERSITY CITY BLVD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28223-0001
Practice Address - Country:US
Practice Address - Phone:704-905-9758
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-24
Last Update Date:2021-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5405103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist