1982128138 NPI number — MRS. RENEE LACHANCE GEORGE LCSW

Table of content: MRS. RENEE LACHANCE GEORGE LCSW (NPI 1982128138)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1982128138 NPI number — MRS. RENEE LACHANCE GEORGE LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GEORGE
Provider First Name:
RENEE
Provider Middle Name:
LACHANCE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LCSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1982128138
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/18/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1 ROYCE CIR STE 104
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
STORRS
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06268-2270
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
860-487-9200
Provider Business Mailing Address Fax Number:
860-487-9222

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
UCONN HEALTH CENTER IOP 263 FARMINGTON
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FARMINGTON
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06030-0001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
860-679-2571
Provider Business Practice Location Address Fax Number:
860-679-1489
Provider Enumeration Date:
07/31/2017

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  009810 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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