Provider Demographics
NPI:1053471763
Name:KUECKS-MORGAN, REGINA LEIGH (PHD)
Entity Type:Individual
Prefix:DR
First Name:REGINA
Middle Name:LEIGH
Last Name:KUECKS-MORGAN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32 BELAIR AVE
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02906-2411
Mailing Address - Country:US
Mailing Address - Phone:401-861-5085
Mailing Address - Fax:401-751-1005
Practice Address - Street 1:295 ANGELL ST
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02906-2119
Practice Address - Country:US
Practice Address - Phone:401-751-1005
Practice Address - Fax:401-751-1005
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIPS00773103TC0700X, 103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Not Answered103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI26429-5OtherBLUE CROSS BLUE SHIELD
RI210158OtherUNITED BEHAVIORAL HEALTH
RIRK56885Medicaid
RI1040290OtherBEACON NEIGHBORHOOD HEALT