Provider Demographics
NPI:1164588505
Name:LINDER, RENAE (LCSW)
Entity Type:Individual
Prefix:
First Name:RENAE
Middle Name:
Last Name:LINDER
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 1:193 BLUE RAVINE RD
Mailing Address - Street 2:170
Mailing Address - City:FOLSOM
Mailing Address - State:CA
Mailing Address - Zip Code:95630-4756
Mailing Address - Country:US
Mailing Address - Phone:916-608-0714
Mailing Address - Fax:916-608-0717
Practice Address - Street 1:193 BLUE RAVINE RD
Practice Address - Street 2:170
Practice Address - City:FOLSOM
Practice Address - State:CA
Practice Address - Zip Code:95630-4756
Practice Address - Country:US
Practice Address - Phone:916-608-0714
Practice Address - Fax:916-608-0717
Is Sole Proprietor?:No
Enumeration Date:2006-12-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS184641041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CALCS18464OtherLICENSED SOCIAL WORKER