Provider Demographics
NPI:1235379546
Name:CONCEPCION, RENEE (LISW-S, LICDC-CS)
Entity Type:Individual
Prefix:
First Name:RENEE
Middle Name:
Last Name:CONCEPCION
Suffix:
Gender:F
Credentials:LISW-S, LICDC-CS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8147 EMERALD WINDS CIR
Mailing Address - Street 2:
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33473-7837
Mailing Address - Country:US
Mailing Address - Phone:513-550-2322
Mailing Address - Fax:
Practice Address - Street 1:8147 EMERALD WINDS CIR
Practice Address - Street 2:
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33473-7837
Practice Address - Country:US
Practice Address - Phone:513-550-2322
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-26
Last Update Date:2018-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH101152101YA0400X
OHI.11000761041C0700X
FLSW137711041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)