Provider Demographics
NPI:1124496344
Name:HARRELL, RENEE (ASW)
Entity type:Individual
Prefix:
First Name:RENEE
Middle Name:
Last Name:HARRELL
Suffix:
Gender:F
Credentials:ASW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5150 SUNRISE BLVD
Mailing Address - Street 2:SUITE G5
Mailing Address - City:FAIR OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:95628-4939
Mailing Address - Country:US
Mailing Address - Phone:916-965-3807
Mailing Address - Fax:
Practice Address - Street 1:5150 SUNRISE BLVD
Practice Address - Street 2:SUITE G5
Practice Address - City:FAIR OAKS
Practice Address - State:CA
Practice Address - Zip Code:95628-4939
Practice Address - Country:US
Practice Address - Phone:916-965-3807
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-03
Last Update Date:2015-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker