Provider Demographics
NPI:1437260734
Name:FROST, RENEE K (LCSW)
Entity Type:Individual
Prefix:
First Name:RENEE
Middle Name:K
Last Name:FROST
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1927 E REDFIELD RD
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85283-4221
Mailing Address - Country:US
Mailing Address - Phone:480-838-2626
Mailing Address - Fax:
Practice Address - Street 1:150 S ASH AVE
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85281-2832
Practice Address - Country:US
Practice Address - Phone:480-921-1002
Practice Address - Fax:480-921-4350
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLCSW-00161041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical