Provider Demographics
NPI:1760874341
Name:STEIN, RENEE MYRA (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:RENEE
Middle Name:MYRA
Last Name:STEIN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MISS
Other - First Name:RENEE
Other - Middle Name:MYRA
Other - Last Name:SCHWARTZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BS
Mailing Address - Street 1:11837 SURFBIRD CIRCLE
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32256
Mailing Address - Country:US
Mailing Address - Phone:904-738-7556
Mailing Address - Fax:904-738-7556
Practice Address - Street 1:11837 SURFBIRD CIRCLE
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32256
Practice Address - Country:US
Practice Address - Phone:904-738-7556
Practice Address - Fax:904-738-7556
Is Sole Proprietor?:No
Enumeration Date:2015-02-19
Last Update Date:2015-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW66131041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical