Provider Demographics
NPI:1104583210
Name:NEONORTON, RENYA
Entity type:Individual
Prefix:
First Name:RENYA
Middle Name:
Last Name:NEONORTON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:RENYA
Other - Middle Name:
Other - Last Name:NEONORTON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:144 N YEWDALL ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19139-2541
Mailing Address - Country:US
Mailing Address - Phone:215-515-8058
Mailing Address - Fax:
Practice Address - Street 1:144 N YEWDALL ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19139-2541
Practice Address - Country:US
Practice Address - Phone:215-515-8058
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-23
Last Update Date:2024-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist