Provider Demographics
NPI:1841367166
Name:RENOUF, J. DAVID (LCMHC)
Entity type:Individual
Prefix:
First Name:J. DAVID
Middle Name:
Last Name:RENOUF
Suffix:
Gender:M
Credentials:LCMHC
Other - Prefix:
Other - First Name:JOHN
Other - Middle Name:
Other - Last Name:RENOUF
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:250 COMMERCIAL STREET
Mailing Address - Street 2:SUITE 3004
Mailing Address - City:MANCHESTER
Mailing Address - State:NH
Mailing Address - Zip Code:03101-1118
Mailing Address - Country:US
Mailing Address - Phone:603-668-3050
Mailing Address - Fax:603-668-8666
Practice Address - Street 1:250 COMMERCIAL STREET
Practice Address - Street 2:SUITE 3004
Practice Address - City:MANCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03101-1118
Practice Address - Country:US
Practice Address - Phone:603-668-3050
Practice Address - Fax:603-668-8666
Is Sole Proprietor?:No
Enumeration Date:2006-11-30
Last Update Date:2014-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH167101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH1406518Y0NH01OtherBLUE CROSS
NH1039158OtherCIGNA
NH3076144Medicaid
NH020258994-74OtherHARVARD PILGRIM