Provider Demographics
NPI:1518386630
Name:TASH, RENEE
Entity type:Individual
Prefix:MS
First Name:RENEE
Middle Name:
Last Name:TASH
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 1:103 DOORE RD
Mailing Address - Street 2:
Mailing Address - City:DOVER FOXCROFT
Mailing Address - State:ME
Mailing Address - Zip Code:04426-3224
Mailing Address - Country:US
Mailing Address - Phone:207-343-1998
Mailing Address - Fax:207-947-6872
Practice Address - Street 1:74 DOWD RD
Practice Address - Street 2:
Practice Address - City:BANGOR
Practice Address - State:ME
Practice Address - Zip Code:04401-6700
Practice Address - Country:US
Practice Address - Phone:207-947-6800
Practice Address - Fax:207-947-6872
Is Sole Proprietor?:No
Enumeration Date:2014-04-16
Last Update Date:2014-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC3934101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)