Provider Demographics
NPI:1033179718
Name:MCINTYRE, RENEE ANDERSEN (LCSW)
Entity Type:Individual
Prefix:MS
First Name:RENEE
Middle Name:ANDERSEN
Last Name:MCINTYRE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:57 PENT RD
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:CT
Mailing Address - Zip Code:06443-3263
Mailing Address - Country:US
Mailing Address - Phone:203-245-0289
Mailing Address - Fax:203-245-7270
Practice Address - Street 1:57 PENT RD
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:CT
Practice Address - Zip Code:06443-3263
Practice Address - Country:US
Practice Address - Phone:203-245-0289
Practice Address - Fax:203-245-7270
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0032871041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical