Provider Demographics
NPI:1497881825
Name:RENE, MYRIAM THEZARD (BSW)
Entity Type:Individual
Prefix:
First Name:MYRIAM
Middle Name:THEZARD
Last Name:RENE
Suffix:
Gender:F
Credentials:BSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1340 PARKWAY AVE
Mailing Address - Street 2:
Mailing Address - City:TRENTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08628-3009
Mailing Address - Country:US
Mailing Address - Phone:609-882-4772
Mailing Address - Fax:609-882-5467
Practice Address - Street 1:1340 PARKWAY AVE
Practice Address - Street 2:
Practice Address - City:TRENTON
Practice Address - State:NJ
Practice Address - Zip Code:08628-3009
Practice Address - Country:US
Practice Address - Phone:609-882-4772
Practice Address - Fax:609-882-5467
Is Sole Proprietor?:No
Enumeration Date:2007-02-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health