Provider Demographics
NPI:1952056905
Name:RENE, MARIE M (LMSW)
Entity Type:Individual
Prefix:
First Name:MARIE
Middle Name:M
Last Name:RENE
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:836A FROELICH AVE
Mailing Address - Street 2:
Mailing Address - City:JOINT BASE MDL
Mailing Address - State:NJ
Mailing Address - Zip Code:08640-1817
Mailing Address - Country:US
Mailing Address - Phone:347-813-3315
Mailing Address - Fax:
Practice Address - Street 1:22 CENTURY BLVD STE 220
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37214-3787
Practice Address - Country:US
Practice Address - Phone:615-522-7627
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-18
Last Update Date:2022-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT2184104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker