Provider Demographics
NPI:1700360732
Name:LAROCK-GARY, RENEE KATHERINE (LMHC)
Entity type:Individual
Prefix:
First Name:RENEE
Middle Name:KATHERINE
Last Name:LAROCK-GARY
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:RENEE
Other - Middle Name:KATHERINE
Other - Last Name:SWINTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMHC
Mailing Address - Street 1:5 MOREHOUS DR
Mailing Address - Street 2:
Mailing Address - City:TICONDEROGA
Mailing Address - State:NY
Mailing Address - Zip Code:12883-1110
Mailing Address - Country:US
Mailing Address - Phone:518-480-7208
Mailing Address - Fax:844-283-6959
Practice Address - Street 1:5 MOREHOUS DR
Practice Address - Street 2:
Practice Address - City:TICONDEROGA
Practice Address - State:NY
Practice Address - Zip Code:12883-1110
Practice Address - Country:US
Practice Address - Phone:518-586-4276
Practice Address - Fax:844-283-6959
Is Sole Proprietor?:No
Enumeration Date:2018-09-15
Last Update Date:2022-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008982101YP2500X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional