Renewed Light LLC

Primary specialty

Mental Health Clinic/Center (Including Community Mental Health Center)Taxonomy code 261QM0801X

Legal business name

RENEWED LIGHT LLC

Practice address

1225 N Broad St Ste 1
West Deptford, NJ 08096-1203

Phone

(856) 508-4925

Fax

(856) 861-1216

NPI assigned

Jan 24, 2022

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Nicholas Desimone, LPC,LCADCNPI 1346788676

Title

Ceo/Owner

Phone

(856) 508-4925

Specialties & licenses 1

Addresses

Electronic endpoints 1

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Nicholas Desimone

  • Professional Counselor
  • Laurel Springs, NJ
  • NPI 1346788676
  NPD Authorized official
• Jessica Hoofnagle, LPCMH, LPC, NCC

  • Professional Counselor
  • Wilmington, DE
  • NPI 1821627027
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1642982400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1642982400000",
    "number": "1104578889",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1225 N BROAD ST STE 1",
            "city": "WEST DEPTFORD",
            "state": "NJ",
            "postal_code": "080961203",
            "telephone_number": "856-508-4925",
            "fax_number": "856-861-1216"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1225 N BROAD ST STE 1",
            "city": "WEST DEPTFORD",
            "state": "NJ",
            "postal_code": "080961203",
            "telephone_number": "856-508-4925",
            "fax_number": "856-861-1216"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RENEWED LIGHT LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-01-24",
        "last_updated": "2022-01-24",
        "certification_date": "2022-01-20",
        "status": "A",
        "authorized_official_last_name": "DESIMONE",
        "authorized_official_first_name": "NICHOLAS",
        "authorized_official_title_or_position": "CEO/OWNER",
        "authorized_official_telephone_number": "856-508-4925",
        "authorized_official_credential": "LPC,LCADC"
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "CollabrativeMD",
            "affiliation": "N",
            "endpointDescription": "patient portal",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "patient portal",
            "address_1": "1225 N Broad St Ste 1",
            "city": "West Deptford",
            "state": "NJ",
            "country_code": "US",
            "postal_code": "080961203",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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• Mental Health Clinic/Center (Including Community Mental Health Center) in West Deptford, NJ
• Providers in West Deptford, NJ by specialty
• Mental Health Clinic/Center (Including Community Mental Health Center) in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 24, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.