Provider Demographics
NPI:1114237302
Name:REGENBOGEN GROUP, JOYCE (CCC SPL, TSSH, SBL)
Entity Type:Individual
Prefix:
First Name:JOYCE
Middle Name:
Last Name:REGENBOGEN GROUP
Suffix:
Gender:F
Credentials:CCC SPL, TSSH, SBL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:699 W 239TH ST APT 4F
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10463-1251
Mailing Address - Country:US
Mailing Address - Phone:718-884-5182
Mailing Address - Fax:
Practice Address - Street 1:475 W 250TH ST
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10471-2925
Practice Address - Country:US
Practice Address - Phone:718-884-5182
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-21
Last Update Date:2020-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003909-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist