Provider Demographics
NPI:1386778447
Name:RENAUD, MELANIE ANN SR (LICSW, LADC1)
Entity type:Individual
Prefix:
First Name:MELANIE
Middle Name:ANN
Last Name:RENAUD
Suffix:SR
Gender:F
Credentials:LICSW, LADC1
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 CYPRESS ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLINE
Mailing Address - State:MA
Mailing Address - Zip Code:02445-6870
Mailing Address - Country:US
Mailing Address - Phone:617-650-3522
Mailing Address - Fax:
Practice Address - Street 1:4 CYPRESS ST
Practice Address - Street 2:
Practice Address - City:BROOKLINE
Practice Address - State:MA
Practice Address - Zip Code:02445
Practice Address - Country:US
Practice Address - Phone:617-650-3522
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-14
Last Update Date:2016-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1104851041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical