Provider Demographics
NPI:1578525705
Name:MCGEARY, RENEE CAROLINE (LICSW)
Entity Type:Individual
Prefix:
First Name:RENEE
Middle Name:CAROLINE
Last Name:MCGEARY
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:RENEE
Other - Middle Name:CAROLINE
Other - Last Name:FALLS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LICSW
Mailing Address - Street 1:11126 NASSAU CIR NE
Mailing Address - Street 2:
Mailing Address - City:BLAINE
Mailing Address - State:MN
Mailing Address - Zip Code:55449-5488
Mailing Address - Country:US
Mailing Address - Phone:763-784-9388
Mailing Address - Fax:
Practice Address - Street 1:69 EXCHANGE ST W
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55102-1004
Practice Address - Country:US
Practice Address - Phone:651-232-3000
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN138321041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical