Provider Demographics
NPI:1376804773
Name:SYMONS, REGINA MARIE (BCBA)
Entity Type:Individual
Prefix:MRS
First Name:REGINA
Middle Name:MARIE
Last Name:SYMONS
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:160 WEST ST
Mailing Address - Street 2:BLDG. 1, SUITES F AND G
Mailing Address - City:CROMWELL
Mailing Address - State:CT
Mailing Address - Zip Code:06416-2441
Mailing Address - Country:US
Mailing Address - Phone:869-613-9930
Mailing Address - Fax:
Practice Address - Street 1:160 WEST ST
Practice Address - Street 2:BLDG. 1, SUITES F AND G
Practice Address - City:CROMWELL
Practice Address - State:CT
Practice Address - Zip Code:06416-2441
Practice Address - Country:US
Practice Address - Phone:869-613-9930
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-01
Last Update Date:2012-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT1-05-2232103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst