Provider Demographics
NPI:1669170965
Name:INTESO, RENEE MARIE (RCSWI)
Entity type:Individual
Prefix:MS
First Name:RENEE
Middle Name:MARIE
Last Name:INTESO
Suffix:
Gender:F
Credentials:RCSWI
Other - Prefix:MS
Other - First Name:RENEE
Other - Middle Name:MARIE
Other - Last Name:PETRO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RCSWI
Mailing Address - Street 1:5988 BENT PINE DR APT 382
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32822-3335
Mailing Address - Country:US
Mailing Address - Phone:407-900-9132
Mailing Address - Fax:
Practice Address - Street 1:2479 ALOMA AVE
Practice Address - Street 2:
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32792-2541
Practice Address - Country:US
Practice Address - Phone:407-657-6692
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-16
Last Update Date:2023-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLISW173001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical