Provider Demographics
NPI:1518508126
Name:REGINO, CECELIA
Entity Type:Individual
Prefix:
First Name:CECELIA
Middle Name:
Last Name:REGINO
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 1:579 GIPP DR
Mailing Address - Street 2:
Mailing Address - City:MANTENO
Mailing Address - State:IL
Mailing Address - Zip Code:60950-3572
Mailing Address - Country:US
Mailing Address - Phone:815-922-6266
Mailing Address - Fax:
Practice Address - Street 1:8505 183RD ST STE D
Practice Address - Street 2:
Practice Address - City:TINLEY PARK
Practice Address - State:IL
Practice Address - Zip Code:60487-9353
Practice Address - Country:US
Practice Address - Phone:708-864-2990
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-04
Last Update Date:2019-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ILR250-1169-6646103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst