Provider Demographics
NPI:1538979406
Name:RENATA DRUKH PSYCHOLOGY LLC
Entity type:Organization
Organization Name:RENATA DRUKH PSYCHOLOGY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RENATA
Authorized Official - Middle Name:
Authorized Official - Last Name:DRUKH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-293-8864
Mailing Address - Street 1:10163 MC LAURIN RD E
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32256-6509
Mailing Address - Country:US
Mailing Address - Phone:847-293-8864
Mailing Address - Fax:
Practice Address - Street 1:10163 MC LAURIN RD E
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32256-6509
Practice Address - Country:US
Practice Address - Phone:847-293-8864
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-01-13
Last Update Date:2025-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty