Provider Demographics
NPI:1861934564
Name:TRIM, RENEZE
Entity type:Individual
Prefix:
First Name:RENEZE
Middle Name:
Last Name:TRIM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:285 MARJORIE BLVD
Mailing Address - Street 2:
Mailing Address - City:LONGWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:32750-4631
Mailing Address - Country:US
Mailing Address - Phone:407-272-3013
Mailing Address - Fax:
Practice Address - Street 1:6900 TURKEY LAKE RD
Practice Address - Street 2:SUITE 1-2
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32819-4707
Practice Address - Country:US
Practice Address - Phone:407-370-5357
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-11
Last Update Date:2016-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLIMH15310101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health