Provider Demographics
NPI:1477331908
Name:NIESSNER, RENE J (BT)
Entity Type:Individual
Prefix:MS
First Name:RENE
Middle Name:J
Last Name:NIESSNER
Suffix:
Gender:F
Credentials:BT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 UNION SQUARE WEST
Mailing Address - Street 2:FRNT 1 #1227
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10003-0060
Mailing Address - Country:US
Mailing Address - Phone:347-619-7924
Mailing Address - Fax:
Practice Address - Street 1:247 SKILLMAN AVE APT 1
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11211-1967
Practice Address - Country:US
Practice Address - Phone:347-619-7924
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-18
Last Update Date:2023-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ILBACB660718106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician