Active NPI
Theodore Johnathan Renard, LADC-I
- Addiction (Substance Use Disorder) Counselor
- Marblehead, MA
National Provider Identifier
1801594528
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Addiction (Substance Use Disorder) Counselor
- License
- 16000
- Practice address
- 118 Pleasant St Ste 22B
Marblehead, MA 01945-2344 - Phone
- (617) 680-4094
- NPI assigned
- Feb 21, 2023
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | 16000 | MA | Primary |
Addresses
Primary practice location
118 Pleasant St Ste 22B
Marblehead, MA 01945-2344
Mailing address
21 Portland St Apt 2
Lynn, MA 01902-3271
Phone (617) 680-4094
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective May 19, 2026 through May 19, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 16000 | MA | MD | Addiction (Substance Use Disorder) Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1676937600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1676937600000",
"number": "1801594528",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "21 PORTLAND ST APT 2",
"city": "LYNN",
"state": "MA",
"postal_code": "019023271",
"telephone_number": "617-680-4094"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "118 PLEASANT ST STE 22B",
"city": "MARBLEHEAD",
"state": "MA",
"postal_code": "019452344",
"telephone_number": "617-680-4094"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RENARD",
"first_name": "THEODORE",
"middle_name": "JOHNATHAN",
"credential": "LADC-I",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2023-02-21",
"last_updated": "2023-02-21",
"certification_date": "2022-12-29",
"status": "A"
},
"taxonomies": [
{
"code": "101YA0400X",
"taxonomy_group": "",
"desc": "Counselor, Addiction (Substance Use Disorder)",
"state": "MA",
"license": "16000",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Marblehead, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 21, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.