Provider Demographics
NPI:1932771144
Name:HARTZ, RENEE (MA, MAT, BCBA, LABA)
Entity Type:Individual
Prefix:
First Name:RENEE
Middle Name:
Last Name:HARTZ
Suffix:
Gender:F
Credentials:MA, MAT, BCBA, LABA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:90 PENTUCKET AVE
Mailing Address - Street 2:
Mailing Address - City:LOWELL
Mailing Address - State:MA
Mailing Address - Zip Code:01852-2912
Mailing Address - Country:US
Mailing Address - Phone:315-292-3412
Mailing Address - Fax:
Practice Address - Street 1:19 HAMPSHIRE ST
Practice Address - Street 2:
Practice Address - City:METHUEN
Practice Address - State:MA
Practice Address - Zip Code:01844-6808
Practice Address - Country:US
Practice Address - Phone:508-233-2308
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-15
Last Update Date:2021-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1603103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst