Provider Demographics
NPI:1083802136
Name:THORNTON-ROOP, RENEE (LMSW)
Entity Type:Individual
Prefix:MRS
First Name:RENEE
Middle Name:
Last Name:THORNTON-ROOP
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:955A MOUNTAIN LAUREL CIR SE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87116-1252
Mailing Address - Country:US
Mailing Address - Phone:505-266-6284
Mailing Address - Fax:
Practice Address - Street 1:955A MOUNTAIN LAUREL CIR SE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87116-1252
Practice Address - Country:US
Practice Address - Phone:505-266-6284
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-12
Last Update Date:2008-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMM-065751041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical