Provider Demographics
NPI:1659491066
Name:ROCKLIN, RENEE B (LCSW)
Entity Type:Individual
Prefix:
First Name:RENEE
Middle Name:B
Last Name:ROCKLIN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 W POINT RD
Mailing Address - Street 2:
Mailing Address - City:BRANFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06405-5732
Mailing Address - Country:US
Mailing Address - Phone:203-288-1777
Mailing Address - Fax:203-481-1755
Practice Address - Street 1:288 STATE ST
Practice Address - Street 2:
Practice Address - City:NORTH HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06473-2132
Practice Address - Country:US
Practice Address - Phone:203-288-1777
Practice Address - Fax:203-481-1755
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0011821041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical