Provider Demographics
NPI:1558840686
Name:PETERMAN, RENEE LYNNE (LMSW)
Entity Type:Individual
Prefix:
First Name:RENEE
Middle Name:LYNNE
Last Name:PETERMAN
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:RENEE
Other - Middle Name:LYNNE
Other - Last Name:PETERMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMSW
Mailing Address - Street 1:418 W KALAMAZOO AVE
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49007-3334
Mailing Address - Country:US
Mailing Address - Phone:269-364-6934
Mailing Address - Fax:269-553-7142
Practice Address - Street 1:418 W KALAMAZOO AVE
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49007-3334
Practice Address - Country:US
Practice Address - Phone:269-364-6934
Practice Address - Fax:269-553-7142
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-09
Last Update Date:2020-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
68010863731041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical