Provider Demographics
NPI:1518347483
Name:FALLAH-HAUSMAN, REGINA (MSW, MS ED)
Entity Type:Individual
Prefix:
First Name:REGINA
Middle Name:
Last Name:FALLAH-HAUSMAN
Suffix:
Gender:F
Credentials:MSW, MS ED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:160 CORSON AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10301-2943
Mailing Address - Country:US
Mailing Address - Phone:646-286-1386
Mailing Address - Fax:
Practice Address - Street 1:160 CORSON AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10301-2943
Practice Address - Country:US
Practice Address - Phone:646-286-1386
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-04
Last Update Date:2015-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist