Provider Demographics
NPI:1881848679
Name:HOEKSTRA, RENEE
Entity Type:Individual
Prefix:
First Name:RENEE
Middle Name:
Last Name:HOEKSTRA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 BOYNTON ST
Mailing Address - Street 2:APT. #3
Mailing Address - City:JAMAICA PLAIN
Mailing Address - State:MA
Mailing Address - Zip Code:02130-3209
Mailing Address - Country:US
Mailing Address - Phone:216-538-3747
Mailing Address - Fax:
Practice Address - Street 1:5 WALPOLE ST
Practice Address - Street 2:
Practice Address - City:NORWOOD
Practice Address - State:MA
Practice Address - Zip Code:02062-3351
Practice Address - Country:US
Practice Address - Phone:216-538-3747
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-11-06
Last Update Date:2008-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA8921103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical