Provider Demographics
NPI:1558510750
Name:CHARLES, RENEE D (LCSW-R)
Entity Type:Individual
Prefix:MS
First Name:RENEE
Middle Name:D
Last Name:CHARLES
Suffix:
Gender:F
Credentials:LCSW-R
Other - Prefix:MRS
Other - First Name:RENEE
Other - Middle Name:ALLEN
Other - Last Name:MITCHELL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD, LCSW-R
Mailing Address - Street 1:312 GREENWICH ST
Mailing Address - Street 2:
Mailing Address - City:HEMPSTEAD
Mailing Address - State:NY
Mailing Address - Zip Code:11550-6318
Mailing Address - Country:US
Mailing Address - Phone:516-292-6441
Mailing Address - Fax:516-292-5618
Practice Address - Street 1:312 GREENWICH ST
Practice Address - Street 2:
Practice Address - City:HEMPSTEAD
Practice Address - State:NY
Practice Address - Zip Code:11550-6318
Practice Address - Country:US
Practice Address - Phone:516-292-6441
Practice Address - Fax:516-292-5618
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-11
Last Update Date:2014-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY275321041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical