Provider Demographics
NPI:1619469707
Name:BIGELOW, RENEE SHINIQUE
Entity Type:Individual
Prefix:
First Name:RENEE
Middle Name:SHINIQUE
Last Name:BIGELOW
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2301 E MARKET ST APT 45
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90805-5545
Mailing Address - Country:US
Mailing Address - Phone:323-984-0302
Mailing Address - Fax:
Practice Address - Street 1:2301 E MARKET ST APT 45
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90805-5545
Practice Address - Country:US
Practice Address - Phone:323-984-0302
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-04
Last Update Date:2018-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst