Provider Demographics
NPI:1831782408
Name:RENBROOK CENTER FOR MENTAL HEALTH LLC
Entity type:Organization
Organization Name:RENBROOK CENTER FOR MENTAL HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GRACE
Authorized Official - Middle Name:MARGARETE
Authorized Official - Last Name:LILIENTHAL
Authorized Official - Suffix:
Authorized Official - Credentials:PMHNP
Authorized Official - Phone:508-319-9369
Mailing Address - Street 1:241 LITTLETON RD APT 103
Mailing Address - Street 2:
Mailing Address - City:CHELMSFORD
Mailing Address - State:MA
Mailing Address - Zip Code:01824-3461
Mailing Address - Country:US
Mailing Address - Phone:626-497-9439
Mailing Address - Fax:833-434-1428
Practice Address - Street 1:67 S BEDFORD ST STE 400
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:MA
Practice Address - Zip Code:01803-5108
Practice Address - Country:US
Practice Address - Phone:508-319-9369
Practice Address - Fax:833-434-1428
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-15
Last Update Date:2021-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty