Provider Demographics
NPI:1427706076
Name:SOUFER, RENEE S (PHD)
Entity type:Individual
Prefix:DR
First Name:RENEE
Middle Name:S
Last Name:SOUFER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31 CHAPEL LN
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CT
Mailing Address - Zip Code:06878-1615
Mailing Address - Country:US
Mailing Address - Phone:650-422-4011
Mailing Address - Fax:
Practice Address - Street 1:57 W 57TH ST STE 1007
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10019-2802
Practice Address - Country:US
Practice Address - Phone:212-658-0110
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-14
Last Update Date:2025-07-22
Deactivation Date:2022-09-09
Deactivation Code:
Reactivation Date:2025-07-22
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program