Provider Demographics
NPI:1699904193
Name:RENBERG, FRANK STANLEY (LLP)
Entity type:Individual
Prefix:MR
First Name:FRANK
Middle Name:STANLEY
Last Name:RENBERG
Suffix:
Gender:M
Credentials:LLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:967 SPAULDING AVE SE
Mailing Address - Street 2:SUITE D
Mailing Address - City:ADA
Mailing Address - State:MI
Mailing Address - Zip Code:49301-3700
Mailing Address - Country:US
Mailing Address - Phone:616-550-4789
Mailing Address - Fax:
Practice Address - Street 1:967 SPAULDING AVE SE
Practice Address - Street 2:SUITE D
Practice Address - City:ADA
Practice Address - State:MI
Practice Address - Zip Code:49301-3700
Practice Address - Country:US
Practice Address - Phone:616-550-4789
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-07
Last Update Date:2009-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301009637103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist