Provider Demographics
NPI:1073400297
Name:CULL, RENEE (LCSW)
Entity type:Individual
Prefix:
First Name:RENEE
Middle Name:
Last Name:CULL
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:RENEE
Other - Middle Name:CULL
Other - Last Name:GROSSENBACHER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1505 BANTAM RD
Mailing Address - Street 2:
Mailing Address - City:BANTAM
Mailing Address - State:CT
Mailing Address - Zip Code:06750-1033
Mailing Address - Country:US
Mailing Address - Phone:203-417-0659
Mailing Address - Fax:
Practice Address - Street 1:1505 BANTAM RD
Practice Address - Street 2:
Practice Address - City:BANTAM
Practice Address - State:CT
Practice Address - Zip Code:06750-1033
Practice Address - Country:US
Practice Address - Phone:203-417-0659
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-20
Last Update Date:2025-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0052421041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical