Provider Demographics
NPI:1366161762
Name:RENEWED LIFE MENTAL HEALTH COUNSELING
Entity type:Organization
Organization Name:RENEWED LIFE MENTAL HEALTH COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PSYCHOTHERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:MARISSA
Authorized Official - Middle Name:L
Authorized Official - Last Name:FELDER
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC, NCC, CIMHP
Authorized Official - Phone:631-640-2088
Mailing Address - Street 1:116 BROADWAY STE 3
Mailing Address - Street 2:
Mailing Address - City:AMITYVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11701-2797
Mailing Address - Country:US
Mailing Address - Phone:631-640-2088
Mailing Address - Fax:
Practice Address - Street 1:116 BROADWAY STE 3
Practice Address - Street 2:
Practice Address - City:AMITYVILLE
Practice Address - State:NY
Practice Address - Zip Code:11701-2797
Practice Address - Country:US
Practice Address - Phone:631-640-2088
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-26
Last Update Date:2022-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty