Provider Demographics
NPI:1578016630
Name:ZEOLI, RENEE (LCSW, CASAC)
Entity Type:Individual
Prefix:
First Name:RENEE
Middle Name:
Last Name:ZEOLI
Suffix:
Gender:F
Credentials:LCSW, CASAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36 ROOSEVELT AVE
Mailing Address - Street 2:
Mailing Address - City:NESCONSET
Mailing Address - State:NY
Mailing Address - Zip Code:11767-2408
Mailing Address - Country:US
Mailing Address - Phone:631-786-4478
Mailing Address - Fax:
Practice Address - Street 1:36 ROOSEVELT AVE
Practice Address - Street 2:
Practice Address - City:NESCONSET
Practice Address - State:NY
Practice Address - Zip Code:11767-2408
Practice Address - Country:US
Practice Address - Phone:631-786-4478
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-25
Last Update Date:2016-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0809641041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical