Provider Demographics
NPI:1447589890
Name:DICKENS, REGINA LEE
Entity Type:Individual
Prefix:MISS
First Name:REGINA
Middle Name:LEE
Last Name:DICKENS
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 1:3356 ADELINE ST
Mailing Address - Street 2:
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94703-2737
Mailing Address - Country:US
Mailing Address - Phone:510-985-0500
Mailing Address - Fax:510-985-8358
Practice Address - Street 1:3356 ADELINE ST
Practice Address - Street 2:
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94703-2737
Practice Address - Country:US
Practice Address - Phone:510-985-0500
Practice Address - Fax:510-985-8358
Is Sole Proprietor?:No
Enumeration Date:2009-12-14
Last Update Date:2009-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator