Provider Demographics
NPI:1194385948
Name:HAAS, RENEE DIANE (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:RENEE
Middle Name:DIANE
Last Name:HAAS
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 1:630 KINGS CT
Mailing Address - Street 2:
Mailing Address - City:UKIAH
Mailing Address - State:CA
Mailing Address - Zip Code:95482-5003
Mailing Address - Country:US
Mailing Address - Phone:707-468-7700
Mailing Address - Fax:
Practice Address - Street 1:630 KINGS CT
Practice Address - Street 2:
Practice Address - City:UKIAH
Practice Address - State:CA
Practice Address - Zip Code:95482-5003
Practice Address - Country:US
Practice Address - Phone:707-468-7700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-14
Last Update Date:2019-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA884781041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical