Provider Demographics
NPI:1164620274
Name:CHILDERS, REGINA (BS)
Entity Type:Individual
Prefix:MRS
First Name:REGINA
Middle Name:
Last Name:CHILDERS
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:69 HANOVER ST
Mailing Address - Street 2:
Mailing Address - City:WALLINGFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06492-1641
Mailing Address - Country:US
Mailing Address - Phone:203-284-3719
Mailing Address - Fax:
Practice Address - Street 1:790 GRAND AVE
Practice Address - Street 2:
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06511-4941
Practice Address - Country:US
Practice Address - Phone:203-789-1681
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-10
Last Update Date:2007-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool