Provider Demographics
NPI:1154864247
Name:DOWNEY, RENEE SUZANNE
Entity Type:Individual
Prefix:
First Name:RENEE
Middle Name:SUZANNE
Last Name:DOWNEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:63 W LANCASTER AVE
Mailing Address - Street 2:SUITE 2
Mailing Address - City:ARDMORE
Mailing Address - State:PA
Mailing Address - Zip Code:19003-1413
Mailing Address - Country:US
Mailing Address - Phone:610-314-7996
Mailing Address - Fax:
Practice Address - Street 1:63 W. LANCASTER AVE.
Practice Address - Street 2:SUITE 2
Practice Address - City:ARDMORE
Practice Address - State:PA
Practice Address - Zip Code:19003
Practice Address - Country:US
Practice Address - Phone:610-314-7996
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-22
Last Update Date:2016-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC009204101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional