Provider Demographics
NPI:1326200098
Name:SUMPTER, RENEE ROBIN (LCSW-R)
Entity Type:Individual
Prefix:MS
First Name:RENEE
Middle Name:ROBIN
Last Name:SUMPTER
Suffix:
Gender:F
Credentials:LCSW-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13449 166TH PL
Mailing Address - Street 2:APT. 11C
Mailing Address - City:JAMAICA
Mailing Address - State:NY
Mailing Address - Zip Code:11434-3844
Mailing Address - Country:US
Mailing Address - Phone:718-527-8873
Mailing Address - Fax:
Practice Address - Street 1:22 CHAPEL ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11201-1903
Practice Address - Country:US
Practice Address - Phone:718-260-2970
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-25
Last Update Date:2008-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY035564101YM0800X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health