Provider Demographics
NPI:1366594343
Name:CANTWELL, RENEE (EDD)
Entity type:Individual
Prefix:DR
First Name:RENEE
Middle Name:
Last Name:CANTWELL
Suffix:
Gender:F
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:299 INDUSTRIAL PARK RD
Mailing Address - Street 2:
Mailing Address - City:NAZARETH
Mailing Address - State:PA
Mailing Address - Zip Code:18064-2439
Mailing Address - Country:US
Mailing Address - Phone:610-504-6122
Mailing Address - Fax:610-365-2506
Practice Address - Street 1:299 INDUSTRIAL PARK RD
Practice Address - Street 2:
Practice Address - City:NAZARETH
Practice Address - State:PA
Practice Address - Zip Code:18064-2439
Practice Address - Country:US
Practice Address - Phone:610-504-6122
Practice Address - Fax:610-365-2506
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-18
Last Update Date:2024-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS016168103T00000X, 103TC0700X
103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical