Provider Demographics
NPI:1548304090
Name:BROCHESTER, RENEE (LICSW)
Entity type:Individual
Prefix:MS
First Name:RENEE
Middle Name:
Last Name:BROCHESTER
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 LAFAYETTE ST STE 305
Mailing Address - Street 2:
Mailing Address - City:PAWTUCKET
Mailing Address - State:RI
Mailing Address - Zip Code:02860-6008
Mailing Address - Country:US
Mailing Address - Phone:401-351-5633
Mailing Address - Fax:401-331-9750
Practice Address - Street 1:100 LAFAYETTE ST STE 305
Practice Address - Street 2:
Practice Address - City:PAWTUCKET
Practice Address - State:RI
Practice Address - Zip Code:02860-6008
Practice Address - Country:US
Practice Address - Phone:401-351-5633
Practice Address - Fax:401-331-9750
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-17
Last Update Date:2020-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA96791041C0700X
MA1076371041C0700X
RIISW008171041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical