Provider Demographics
NPI:1407529829
Name:STANDAGE, RENEE N (LCPC)
Entity Type:Individual
Prefix:
First Name:RENEE
Middle Name:N
Last Name:STANDAGE
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:524 ALEWIVE RD
Mailing Address - Street 2:
Mailing Address - City:KENNEBUNK
Mailing Address - State:ME
Mailing Address - Zip Code:04043-6017
Mailing Address - Country:US
Mailing Address - Phone:207-370-8329
Mailing Address - Fax:
Practice Address - Street 1:36 MAIN ST STE D
Practice Address - Street 2:
Practice Address - City:KENNEBUNK
Practice Address - State:ME
Practice Address - Zip Code:04043-5000
Practice Address - Country:US
Practice Address - Phone:207-370-8329
Practice Address - Fax:207-967-4929
Is Sole Proprietor?:No
Enumeration Date:2021-07-30
Last Update Date:2024-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
MECC7341101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health