| Doctor Name: | KYLE A. RENICHE |
| NPI Number: | 1013164888 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | LCSW |
| License Number: | LC 8308 |
| Business Practice Address: | 12 Union St Rockland, ME - 048412739 |
| Business Phone Number: | 2077014402 |
| Business Fax Number: | 2077014486 |
| Mailing Address: | 78 Atlantic Place, SOUTH PORTLAND |
| State: | ME |
| Postal Code: | 041062316 |
| Phone Number: | 2078426556 |
| Fax Number: | 2078427773 |
| NPI Enumeration Date: | 08/25/2008 |
| NPI Last Update Date: | 12/07/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 1041C0700X |
| License Number: | LC 8308 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | ME |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Social Worker |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | A social worker who holds a master |