Provider Demographics
NPI:1508962143
Name:REGAZZI, MICHELINA L (PHD)
Entity Type:Individual
Prefix:DR
First Name:MICHELINA
Middle Name:L
Last Name:REGAZZI
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5777 MADISON AVE
Mailing Address - Street 2:SUITE 306
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95841-3315
Mailing Address - Country:US
Mailing Address - Phone:916-334-7933
Mailing Address - Fax:916-334-7902
Practice Address - Street 1:5777 MADISON AVE
Practice Address - Street 2:SUITE 306
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95841-3315
Practice Address - Country:US
Practice Address - Phone:916-334-7933
Practice Address - Fax:916-334-7902
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY15973103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical