Provider Demographics
NPI:1992958193
Name:STOCKTON, RENE (MSW)
Entity type:Individual
Prefix:MR
First Name:RENE
Middle Name:
Last Name:STOCKTON
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6435 YELLOWSTONE BLVD APT 5E
Mailing Address - Street 2:C/O KENNETH BOURNE
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375-1720
Mailing Address - Country:US
Mailing Address - Phone:646-652-7133
Mailing Address - Fax:
Practice Address - Street 1:6435 YELLOWSTONE BLVD APT 5E
Practice Address - Street 2:C/O KENNETH BOURNE
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375-1720
Practice Address - Country:US
Practice Address - Phone:646-652-7133
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-31
Last Update Date:2008-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No102X00000XBehavioral Health & Social Service ProvidersPoetry Therapist