Provider Demographics
NPI:1811014137
Name:PEYTON, RENEE DEYETTE (LCSW)
Entity Type:Individual
Prefix:
First Name:RENEE
Middle Name:DEYETTE
Last Name:PEYTON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:RENEE RISING SUN
Other - Middle Name:
Other - Last Name:DEYETTE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:14120 BEACH BLVD
Mailing Address - Street 2:SUITE 213
Mailing Address - City:WESTMINSTER
Mailing Address - State:CA
Mailing Address - Zip Code:92683-4454
Mailing Address - Country:US
Mailing Address - Phone:714-898-9040
Mailing Address - Fax:714-894-3083
Practice Address - Street 1:14120 BEACH BLVD
Practice Address - Street 2:SUITE 213
Practice Address - City:WESTMINSTER
Practice Address - State:CA
Practice Address - Zip Code:92683-4454
Practice Address - Country:US
Practice Address - Phone:714-898-9040
Practice Address - Fax:714-894-3083
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-23
Last Update Date:2013-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY069713-11041C0700X
CA273411041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00639496Medicaid