Provider Demographics
NPI:1912590290
Name:RENEAU, KATHRYN PRAY (LCSW)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:PRAY
Last Name:RENEAU
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:122 WHISPER ROCK DR
Mailing Address - Street 2:
Mailing Address - City:PONTE VEDRA
Mailing Address - State:FL
Mailing Address - Zip Code:32081-6186
Mailing Address - Country:US
Mailing Address - Phone:904-874-2177
Mailing Address - Fax:
Practice Address - Street 1:122 WHISPER ROCK DR
Practice Address - Street 2:
Practice Address - City:PONTE VEDRA
Practice Address - State:FL
Practice Address - Zip Code:32081-6186
Practice Address - Country:US
Practice Address - Phone:904-874-2177
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-17
Last Update Date:2021-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW116051041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical