Provider Demographics
NPI:1659182731
Name:RENNOCK, TOSHA
Entity type:Individual
Prefix:MS
First Name:TOSHA
Middle Name:
Last Name:RENNOCK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:163 MIDDLEFIELD ST
Mailing Address - Street 2:
Mailing Address - City:HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06112-1945
Mailing Address - Country:US
Mailing Address - Phone:860-987-8162
Mailing Address - Fax:
Practice Address - Street 1:163 MIDDLEFIELD ST
Practice Address - Street 2:
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06112-1945
Practice Address - Country:US
Practice Address - Phone:860-987-8162
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-16
Last Update Date:2025-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician