Provider Demographics
NPI:1275840514
Name:PROCTOR, RENEELYNN MARIE
Entity type:Individual
Prefix:
First Name:RENEELYNN
Middle Name:MARIE
Last Name:PROCTOR
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 CLEARWATER DR
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02360-1539
Mailing Address - Country:US
Mailing Address - Phone:508-562-7738
Mailing Address - Fax:
Practice Address - Street 1:50 ALDRIN RD
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02360-4827
Practice Address - Country:US
Practice Address - Phone:508-830-0000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-08
Last Update Date:2025-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MALMHC10938101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health