Provider Demographics
NPI:1346266400
Name:MIONE, RENEE (LCSW)
Entity type:Individual
Prefix:
First Name:RENEE
Middle Name:
Last Name:MIONE
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 1:522 WILSHIRE BLVD.
Mailing Address - Street 2:
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90401
Mailing Address - Country:US
Mailing Address - Phone:310-922-1061
Mailing Address - Fax:
Practice Address - Street 1:522 WILSHIRE BLVD
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90401-1412
Practice Address - Country:US
Practice Address - Phone:310-922-1061
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-14
Last Update Date:2024-05-23
Deactivation Date:2016-03-07
Deactivation Code:
Reactivation Date:2024-05-23
Provider Licenses
StateLicense IDTaxonomies
LCS 16356101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health