| Renew Counseling Practicing Licensed Clinical Social Work Pllc | |
|
8 Denison Pkwy E Ste 305 Corning NY 14830-2644 | |
| (607) 654-4450 | |
| Not Available |
| Full Name | Renew Counseling Practicing Licensed Clinical Social Work Pllc |
|---|---|
| Speciality | Social Worker |
| Location | 8 Denison Pkwy E Ste 305, Corning, New York |
| Authorized Official Name and Position | Jennifer Decapria Close (OWNER/THERAPIST) |
| Authorized Official Contact | 6076544450 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Renew Counseling Practicing Licensed Clinical Social Work Pllc 8 Denison Pkwy E Ste 305 Corning NY 14830-2644 Ph: (607) 654-4450 | Renew Counseling Practicing Licensed Clinical Social Work Pllc 8 Denison Pkwy E Ste 305 Corning NY 14830-2644 Ph: (607) 654-4450 |
| NPI Number | 1497451769 |
|---|---|
| Provider Enumeration Date | 02/07/2023 |
| Last Update Date | 02/07/2023 |
| Certification Date | 02/07/2023 |
| Medicare PECOS PAC ID | 4284008889 |
|---|---|
| Medicare Enrollment ID | O20230322001773 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1497451769 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
| Provider Name | Beverly Boughton |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1528299492 PECOS PAC ID: 2365748969 Enrollment ID: I20160308001607 |
| Provider Name | Jennifer Decapria Close |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1619471422 PECOS PAC ID: 3870848815 Enrollment ID: I20180615001465 |
| Provider Name | Jolie Merrill |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1225690399 PECOS PAC ID: 7810361417 Enrollment ID: I20230411001074 |
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