Provider Demographics
NPI:1861515264
Name:UTZ, RENAE M (LCSW)
Entity type:Individual
Prefix:
First Name:RENAE
Middle Name:M
Last Name:UTZ
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1504 LEXINGTON WAY
Mailing Address - Street 2:
Mailing Address - City:MORGANTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19543-8854
Mailing Address - Country:US
Mailing Address - Phone:610-913-6996
Mailing Address - Fax:
Practice Address - Street 1:1140 MCDERMOTT DR
Practice Address - Street 2:SUITE 100-101
Practice Address - City:WEST CHESTER
Practice Address - State:PA
Practice Address - Zip Code:19380-4043
Practice Address - Country:US
Practice Address - Phone:610-430-6141
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0147891041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical