Provider Demographics
NPI:1033696794
Name:REGO, KRISTIE M
Entity Type:Individual
Prefix:
First Name:KRISTIE
Middle Name:M
Last Name:REGO
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 1:1064 TOBEY ST
Mailing Address - Street 2:
Mailing Address - City:NEW BEDFORD
Mailing Address - State:MA
Mailing Address - Zip Code:02745-4322
Mailing Address - Country:US
Mailing Address - Phone:774-225-2984
Mailing Address - Fax:
Practice Address - Street 1:1064 TOBEY ST
Practice Address - Street 2:
Practice Address - City:NEW BEDFORD
Practice Address - State:MA
Practice Address - Zip Code:02745-4322
Practice Address - Country:US
Practice Address - Phone:774-225-2984
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-25
Last Update Date:2018-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No251B00000XAgenciesCase Management