Provider Demographics
NPI:1164647186
Name:GROMAN, RENEE M (LISW)
Entity type:Individual
Prefix:
First Name:RENEE
Middle Name:M
Last Name:GROMAN
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1075 HORACE ST
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43606-4859
Mailing Address - Country:US
Mailing Address - Phone:419-407-8725
Mailing Address - Fax:419-725-6111
Practice Address - Street 1:1075 HORACE ST
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43606
Practice Address - Country:US
Practice Address - Phone:419-407-8725
Practice Address - Fax:419-725-6111
Is Sole Proprietor?:No
Enumeration Date:2007-04-16
Last Update Date:2016-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI 00099331041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical