Provider Demographics
NPI:1891905113
Name:CLAUSELLE, RENEE (PSYD)
Entity Type:Individual
Prefix:DR
First Name:RENEE
Middle Name:
Last Name:CLAUSELLE
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:630 DOROTHEA LN
Mailing Address - Street 2:
Mailing Address - City:ELMONT
Mailing Address - State:NY
Mailing Address - Zip Code:11003-4520
Mailing Address - Country:US
Mailing Address - Phone:516-668-1023
Mailing Address - Fax:516-394-4767
Practice Address - Street 1:630 DOROTHEA LN
Practice Address - Street 2:
Practice Address - City:ELMONT
Practice Address - State:NY
Practice Address - Zip Code:11003-4520
Practice Address - Country:US
Practice Address - Phone:516-668-1023
Practice Address - Fax:516-394-4767
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY16469103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist