Provider Demographics
NPI:1558463646
Name:RHODES, RENEE H (PHD)
Entity Type:Individual
Prefix:
First Name:RENEE
Middle Name:H
Last Name:RHODES
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 CHANNING ST
Mailing Address - Street 2:
Mailing Address - City:NEW LONDON
Mailing Address - State:CT
Mailing Address - Zip Code:06320-5735
Mailing Address - Country:US
Mailing Address - Phone:860-663-5514
Mailing Address - Fax:
Practice Address - Street 1:24 CHANNING ST
Practice Address - Street 2:
Practice Address - City:NEW LONDON
Practice Address - State:CT
Practice Address - Zip Code:06320-5735
Practice Address - Country:US
Practice Address - Phone:860-663-5514
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001808103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT3132835OtherOXFORD
CT060001808CT03OtherBC/BS