Individual provider Active NPI

Renee Lynn Todd, LCSW

  • Clinical Social Worker
  • Longview, TX
National Provider Identifier
1467561209
Registry record updated Aug 18, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
60852 Issued in TX
Practice address
107 Woodbine PL
Longview, TX 75601-2912
Phone
(800) 446-8253
Fax
(903) 234-1639
NPI assigned
Aug 29, 2006
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Aug 18, 2020

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X 60852 TX Primary
Clinical Social Worker 1041C0700X ASW12258 CA

Addresses

Primary practice location

107 Woodbine PL
Longview, TX 75601-2912

Mailing address

107 Woodbine PL
Longview, TX 75601-2912
Phone (800) 446-8253

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20200824002800 TX Practitioner - Clinical Social Worker 6305263237 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
ASW12258CAMDClinical Social Worker
60852TXMDPharmacist

Practice roles

OrganizationSpecialtyStatusNew patients
Grow Healthcare Group PA Clinical CurrentSince Oct 18, 2023 Accepting new patients

Locations

66 W Flagler St
Ste 900
Miami, FL 33130
Phone (786) 244-7711

700 Milam St
Ste 1300
Houston, TX 77002
Phone (281) 801-8391

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1156809600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1597708800000",
    "number": "1467561209",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "107 WOODBINE PL",
            "city": "LONGVIEW",
            "state": "TX",
            "postal_code": "756012912",
            "telephone_number": "800-446-8253",
            "fax_number": "903-234-1639"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "107 WOODBINE PL",
            "city": "LONGVIEW",
            "state": "TX",
            "postal_code": "756012912",
            "telephone_number": "800-446-8253",
            "fax_number": "903-234-1639"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TODD",
        "first_name": "RENEE",
        "middle_name": "LYNN",
        "name_prefix": "Mrs.",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-08-29",
        "last_updated": "2020-08-18",
        "certification_date": "2020-08-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "TX",
            "license": "60852",
            "primary": true
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "CA",
            "license": "ASW12258",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Longview, TX

Sources for this page

Verify at the official NPI Registry.