Provider Demographics
NPI:1225319353
Name:RENE, JON (PSY)
Entity Type:Individual
Prefix:DR
First Name:JON
Middle Name:
Last Name:RENE
Suffix:
Gender:M
Credentials:PSY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:56G S PROSPECT ST # G
Mailing Address - Street 2:G
Mailing Address - City:HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06106-1937
Mailing Address - Country:US
Mailing Address - Phone:860-869-0241
Mailing Address - Fax:
Practice Address - Street 1:56 G S PROSPECT ST # G
Practice Address - Street 2:G
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06106-1937
Practice Address - Country:US
Practice Address - Phone:860-869-0241
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-02
Last Update Date:2011-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator