Provider Demographics
NPI:1407329089
Name:RICHBERG, RENEE ANN BONIFACIO (LCPC)
Entity type:Individual
Prefix:
First Name:RENEE
Middle Name:ANN BONIFACIO
Last Name:RICHBERG
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:RENEE
Other - Middle Name:ANN
Other - Last Name:BONIFACIO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCPC
Mailing Address - Street 1:35 LAKESIDE DR
Mailing Address - Street 2:
Mailing Address - City:GREENBELT
Mailing Address - State:MD
Mailing Address - Zip Code:20770-1973
Mailing Address - Country:US
Mailing Address - Phone:941-661-7133
Mailing Address - Fax:
Practice Address - Street 1:35 LAKESIDE DR
Practice Address - Street 2:
Practice Address - City:GREENBELT
Practice Address - State:MD
Practice Address - Zip Code:20770-1973
Practice Address - Country:US
Practice Address - Phone:941-661-7133
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-07
Last Update Date:2025-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC11570101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health