Provider Demographics
NPI:1245347970
Name:NERENBERG, MARK A (MAS/MSW/)
Entity type:Individual
Prefix:MR
First Name:MARK
Middle Name:A
Last Name:NERENBERG
Suffix:
Gender:M
Credentials:MAS/MSW/
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1616 SPRING VALLEY DR
Mailing Address - Street 2:APT. #14
Mailing Address - City:HUNTINGTON
Mailing Address - State:WV
Mailing Address - Zip Code:25704-9374
Mailing Address - Country:US
Mailing Address - Phone:239-218-0824
Mailing Address - Fax:
Practice Address - Street 1:1540 SPRING VALLEY DR. - DEPT. OF VETERAN AFFAIRS-
Practice Address - Street 2:MENTAL HEALTH SERVICES
Practice Address - City:HUNTINGTON
Practice Address - State:WV
Practice Address - Zip Code:25704
Practice Address - Country:US
Practice Address - Phone:304-429-6741
Practice Address - Fax:304-429-0287
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI-00070971041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical