Provider Demographics
NPI:1609614106
Name:CLESS, RENEE
Entity type:Individual
Prefix:
First Name:RENEE
Middle Name:
Last Name:CLESS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:317 VETERANS DR
Mailing Address - Street 2:
Mailing Address - City:NEW BLOOMFIELD
Mailing Address - State:PA
Mailing Address - Zip Code:17068-8562
Mailing Address - Country:US
Mailing Address - Phone:717-636-3307
Mailing Address - Fax:
Practice Address - Street 1:215 MARKET ST
Practice Address - Street 2:
Practice Address - City:HARRISBURG
Practice Address - State:PA
Practice Address - Zip Code:17101-2116
Practice Address - Country:US
Practice Address - Phone:717-703-1900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-18
Last Update Date:2024-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA141627104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker