Provider Demographics
NPI:1770624223
Name:FOLSOM, RENEE CUTIONGCO (PHD)
Entity type:Individual
Prefix:DR
First Name:RENEE
Middle Name:CUTIONGCO
Last Name:FOLSOM
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:MARIA ELEANOR RENEE
Other - Middle Name:CRUZ
Other - Last Name:CUTIONGCO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:86 BAKER AVENUE EXT STE 301
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:MA
Mailing Address - Zip Code:01742-2132
Mailing Address - Country:US
Mailing Address - Phone:978-341-4992
Mailing Address - Fax:888-631-1092
Practice Address - Street 1:86 BAKER AVENUE EXT STE 301
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:MA
Practice Address - Zip Code:01742-2132
Practice Address - Country:US
Practice Address - Phone:978-341-4992
Practice Address - Fax:888-631-1092
Is Sole Proprietor?:No
Enumeration Date:2007-02-09
Last Update Date:2020-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10030103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist