Provider Demographics
NPI:1134790801
Name:MYRIE, RENEE (LMSW, LPN)
Entity type:Individual
Prefix:MS
First Name:RENEE
Middle Name:
Last Name:MYRIE
Suffix:
Gender:F
Credentials:LMSW, LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 JILLWAY CT APT K
Mailing Address - Street 2:
Mailing Address - City:ESSEX
Mailing Address - State:MD
Mailing Address - Zip Code:21221-5538
Mailing Address - Country:US
Mailing Address - Phone:667-600-9055
Mailing Address - Fax:
Practice Address - Street 1:7474 GREENWAY CENTER DR STE 200
Practice Address - Street 2:
Practice Address - City:GREENBELT
Practice Address - State:MD
Practice Address - Zip Code:20770-3524
Practice Address - Country:US
Practice Address - Phone:240-304-3327
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-05
Last Update Date:2021-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD27414104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD104100000XMedicaid