Provider Demographics
NPI:1639426943
Name:BARNETT, RENEE ELAINE (MS)
Entity Type:Individual
Prefix:MRS
First Name:RENEE
Middle Name:ELAINE
Last Name:BARNETT
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:37 MERRY LN
Mailing Address - Street 2:
Mailing Address - City:JERICHO
Mailing Address - State:NY
Mailing Address - Zip Code:11753-1724
Mailing Address - Country:US
Mailing Address - Phone:516-815-4183
Mailing Address - Fax:
Practice Address - Street 1:37 MERRY LN
Practice Address - Street 2:
Practice Address - City:JERICHO
Practice Address - State:NY
Practice Address - Zip Code:11753-1724
Practice Address - Country:US
Practice Address - Phone:516-815-4183
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-07
Last Update Date:2012-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist