Provider Demographics
NPI:1912786799
Name:NEEDELL, RENATA J
Entity Type:Individual
Prefix:MS
First Name:RENATA
Middle Name:J
Last Name:NEEDELL
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:RENATA
Other - Middle Name:J
Other - Last Name:MAIA DE NEEDELL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:4830 NW 43RD ST APT M194
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32606-4408
Mailing Address - Country:US
Mailing Address - Phone:352-682-4184
Mailing Address - Fax:
Practice Address - Street 1:4830 NW 43RD ST APT M194
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32606-4408
Practice Address - Country:US
Practice Address - Phone:352-682-4184
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-21
Last Update Date:2023-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health