Provider Demographics
NPI:1003974916
Name:CONNOR, REGINA S (LCSW)
Entity Type:Individual
Prefix:MS
First Name:REGINA
Middle Name:S
Last Name:CONNOR
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 1:2101 E JEFFERSON ST
Mailing Address - Street 2:KAISER PERMANENTE MEDICARE ENROLLMENT
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20852-4908
Mailing Address - Country:US
Mailing Address - Phone:301-816-2424
Mailing Address - Fax:
Practice Address - Street 1:10500 SUMMIT AVE
Practice Address - Street 2:KAISER PERMANENTE SUMMIT BEHAVIORAL HEALTH CENTER
Practice Address - City:KENSINGTON
Practice Address - State:MD
Practice Address - Zip Code:20895-2422
Practice Address - Country:US
Practice Address - Phone:301-897-2500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-04
Last Update Date:2012-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD092571041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
Q06530Medicare UPIN
013018K92Medicare ID - Type Unspecified