Provider Demographics
NPI:1316811425
Name:PRINCE, RENEE MARIE (MSW, LSW)
Entity type:Individual
Prefix:
First Name:RENEE
Middle Name:MARIE
Last Name:PRINCE
Suffix:
Gender:F
Credentials:MSW, LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:257 MOUNTAIN CT
Mailing Address - Street 2:
Mailing Address - City:BASALT
Mailing Address - State:CO
Mailing Address - Zip Code:81621-9277
Mailing Address - Country:US
Mailing Address - Phone:719-480-3024
Mailing Address - Fax:
Practice Address - Street 1:207 BASALT CENTER CIRCLE, UNIT 201
Practice Address - Street 2:
Practice Address - City:BASALT
Practice Address - State:CO
Practice Address - Zip Code:81621
Practice Address - Country:US
Practice Address - Phone:719-480-3024
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-10-01
Last Update Date:2025-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COLSW0009926616104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker