Provider Demographics
NPI:1326415761
Name:CLEMENT, REGINA
Entity Type:Individual
Prefix:
First Name:REGINA
Middle Name:
Last Name:CLEMENT
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 1:82 ARBOR DRIVE
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02908
Mailing Address - Country:US
Mailing Address - Phone:401-276-4350
Mailing Address - Fax:401-331-3285
Practice Address - Street 1:153 SUMMER STREET
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02903
Practice Address - Country:US
Practice Address - Phone:401-276-4350
Practice Address - Fax:401-331-3285
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-01
Last Update Date:2016-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker