Provider Demographics
NPI:1073278412
Name:WHITE, REGINE
Entity Type:Individual
Prefix:MISS
First Name:REGINE
Middle Name:
Last Name:WHITE
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 1:52 SWANSON COURT
Mailing Address - Street 2:APT. 35B
Mailing Address - City:BOXBOROUGH
Mailing Address - State:MA
Mailing Address - Zip Code:01719
Mailing Address - Country:US
Mailing Address - Phone:978-844-0654
Mailing Address - Fax:
Practice Address - Street 1:52 SWANSON COURT
Practice Address - Street 2:APT. 35B
Practice Address - City:BOXBOROUGH
Practice Address - State:MA
Practice Address - Zip Code:01719
Practice Address - Country:US
Practice Address - Phone:978-844-0654
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-01
Last Update Date:2021-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician