Provider Demographics
NPI:1982205704
Name:RENAISSANCE CLINICAL SERVICES
Entity Type:Organization
Organization Name:RENAISSANCE CLINICAL SERVICES
Other - Org Name:RENAISSANCE THERAPY DENVER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PSYCHOTHERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:RENEE
Authorized Official - Middle Name:VERONICA
Authorized Official - Last Name:RIVERA
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:303-523-3698
Mailing Address - Street 1:1044 MILWAUKEE ST
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80206-3338
Mailing Address - Country:US
Mailing Address - Phone:303-523-3698
Mailing Address - Fax:
Practice Address - Street 1:4495 HALE PKWY STE 114
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80220-6203
Practice Address - Country:US
Practice Address - Phone:303-523-3698
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-06
Last Update Date:2020-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty