Provider Demographics
NPI:1639735210
Name:FOLZENLOGEN, RENEE TAMARA (LPC, ATR-BC)
Entity Type:Individual
Prefix:
First Name:RENEE
Middle Name:TAMARA
Last Name:FOLZENLOGEN
Suffix:
Gender:F
Credentials:LPC, ATR-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 WITHERSPOON RD
Mailing Address - Street 2:
Mailing Address - City:VERONA
Mailing Address - State:NJ
Mailing Address - Zip Code:07044-2911
Mailing Address - Country:US
Mailing Address - Phone:862-596-5911
Mailing Address - Fax:
Practice Address - Street 1:855 BLOOMFIELD AVE STE 206
Practice Address - Street 2:
Practice Address - City:GLEN RIDGE
Practice Address - State:NJ
Practice Address - Zip Code:07028-1307
Practice Address - Country:US
Practice Address - Phone:862-596-5911
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-19
Last Update Date:2019-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC00673400101YP2500X
17-510221700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No221700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersArt Therapist