Provider Demographics
NPI:1164070165
Name:LEVKOVICH, REGINA
Entity Type:Individual
Prefix:
First Name:REGINA
Middle Name:
Last Name:LEVKOVICH
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 1:652 WASHINGTON ST APT 2
Mailing Address - Street 2:
Mailing Address - City:BROOKLINE
Mailing Address - State:MA
Mailing Address - Zip Code:02446-4549
Mailing Address - Country:US
Mailing Address - Phone:857-207-7156
Mailing Address - Fax:
Practice Address - Street 1:SPAULDING NURSING AND THERAPY CENTER-BRIGHTON
Practice Address - Street 2:100 NORTH BEACON STREET
Practice Address - City:BRIGHTON
Practice Address - State:MA
Practice Address - Zip Code:02134
Practice Address - Country:US
Practice Address - Phone:617-726-9700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-03
Last Update Date:2019-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA221383104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker