Provider Demographics
NPI:1124837539
Name:BLANCO, RENEE (LCSW)
Entity type:Individual
Prefix:
First Name:RENEE
Middle Name:
Last Name:BLANCO
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 RAYMOND CT
Mailing Address - Street 2:
Mailing Address - City:MANALAPAN
Mailing Address - State:NJ
Mailing Address - Zip Code:07726-1556
Mailing Address - Country:US
Mailing Address - Phone:732-692-0506
Mailing Address - Fax:
Practice Address - Street 1:281 HIGHWAY 79 N
Practice Address - Street 2:
Practice Address - City:MORGANVILLE
Practice Address - State:NJ
Practice Address - Zip Code:07751-1157
Practice Address - Country:US
Practice Address - Phone:732-242-9235
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-01
Last Update Date:2025-01-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC063172001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical