| Doctor Name: | RENA SUSAN DEREZIN |
| NPI Number: | 1790923670 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | M.A., L.P.C., N.C.C. |
| License Number: | 5066 |
| Business Practice Address: | 135 Clear Creek Street Black Hawk, CO - 804220418 |
| Business Phone Number: | 3038072750 |
| Business Fax Number: | |
| Mailing Address: | Po Box 139, SILVERTHORNE |
| State: | CO |
| Postal Code: | 804980139 |
| Phone Number: | 3038072750 |
| Fax Number: | |
| NPI Enumeration Date: | 01/30/2009 |
| NPI Last Update Date: | 08/25/2009 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YP2500X |
| License Number: | 5066 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | CO |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Professional |
| Taxonomy Definition: | |