Provider Demographics
NPI:1013626076
Name:DUARTE-HARTMANN, RENEE LYNN
Entity Type:Individual
Prefix:
First Name:RENEE
Middle Name:LYNN
Last Name:DUARTE-HARTMANN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:RENEE
Other - Middle Name:L
Other - Last Name:DUARTE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CASAC
Mailing Address - Street 1:51 PENNANT DR
Mailing Address - Street 2:
Mailing Address - City:MASTIC BEACH
Mailing Address - State:NY
Mailing Address - Zip Code:11951-2012
Mailing Address - Country:US
Mailing Address - Phone:631-525-0050
Mailing Address - Fax:
Practice Address - Street 1:200 WIRELESS BLVD
Practice Address - Street 2:
Practice Address - City:HAUPPAUGE
Practice Address - State:NY
Practice Address - Zip Code:11788-3974
Practice Address - Country:US
Practice Address - Phone:631-873-7373
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-18
Last Update Date:2022-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY33794101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)