Individual
LESLIE L RENNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
25166 MARION AVE, STE 112, PUNTA GORDA, FL 33950-4017
(941) 467-6367
Mailing address
25166 MARION AVE, STE 112, PUNTA GORDA, FL 33950-4017
(941) 467-6367
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
SW6138
FL
104100000X
Social Worker
Primary
SW6138
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
Z1902
BLUE CROSS
FL
Enumeration date
08/15/2006
Last updated
04/18/2012
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