Provider Demographics
NPI:1649914391
Name:HERETH, RENEE (LCSW)
Entity type:Individual
Prefix:
First Name:RENEE
Middle Name:
Last Name:HERETH
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:RENEE
Other - Middle Name:
Other - Last Name:LAFRENIERE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:24 MAXWELL DR # 1071
Mailing Address - Street 2:
Mailing Address - City:CLIFTON PARK
Mailing Address - State:NY
Mailing Address - Zip Code:12065-2920
Mailing Address - Country:US
Mailing Address - Phone:518-281-6204
Mailing Address - Fax:
Practice Address - Street 1:111 5TH AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10003-1005
Practice Address - Country:US
Practice Address - Phone:518-281-6204
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-27
Last Update Date:2025-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY102227104100000X
NY1006791041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker