Provider Demographics
NPI:1306963798
Name:LEVESQUE, RENEE M (MSW, LICSW)
Entity type:Individual
Prefix:MS
First Name:RENEE
Middle Name:M
Last Name:LEVESQUE
Suffix:
Gender:F
Credentials:MSW, LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 WABASHA ST S STE 90
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55107-1819
Mailing Address - Country:US
Mailing Address - Phone:651-925-8453
Mailing Address - Fax:
Practice Address - Street 1:130 WABASHA ST S STE 90
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55107-1819
Practice Address - Country:US
Practice Address - Phone:651-925-8453
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-23
Last Update Date:2019-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FM146761041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NONEOtherNONE