Provider Demographics
NPI:1356668776
Name:SUDOL, RENEE VECERE (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:RENEE
Middle Name:VECERE
Last Name:SUDOL
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MRS
Other - First Name:RENEE
Other - Middle Name:VECERE
Other - Last Name:SUDOL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:253 EMERALD DR
Mailing Address - Street 2:
Mailing Address - City:YARDLEY
Mailing Address - State:PA
Mailing Address - Zip Code:19067-5740
Mailing Address - Country:US
Mailing Address - Phone:267-255-0351
Mailing Address - Fax:
Practice Address - Street 1:5 TEMPLE CT
Practice Address - Street 2:
Practice Address - City:PENNINGTON
Practice Address - State:NJ
Practice Address - Zip Code:08534-5151
Practice Address - Country:US
Practice Address - Phone:267-255-0351
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-25
Last Update Date:2018-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC048546001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical