Provider Demographics
NPI:1861726267
Name:BISNAIRE, RENEE (MSW, LDM, LCSW)
Entity type:Individual
Prefix:
First Name:RENEE
Middle Name:
Last Name:BISNAIRE
Suffix:
Gender:F
Credentials:MSW, LDM, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:38880 DEXTER RD STE 376
Mailing Address - Street 2:
Mailing Address - City:DEXTER
Mailing Address - State:OR
Mailing Address - Zip Code:97431-9775
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2355 STATE ST STE 101
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97301-4541
Practice Address - Country:US
Practice Address - Phone:541-972-3830
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-01
Last Update Date:2022-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORDEM-LD-10127927175M00000X
ORL111091041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No175M00000XOther Service ProvidersMidwife, Lay