Provider Demographics
NPI:1528204245
Name:LEDERMAN, REGINA (RN, BSN, MA, PHD)
Entity Type:Individual
Prefix:DR
First Name:REGINA
Middle Name:
Last Name:LEDERMAN
Suffix:
Gender:F
Credentials:RN, BSN, MA, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3607 GRAMERCY ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77025-1320
Mailing Address - Country:US
Mailing Address - Phone:713-666-0172
Mailing Address - Fax:713-526-4342
Practice Address - Street 1:2524 NOTTINGHAM ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77005-1412
Practice Address - Country:US
Practice Address - Phone:713-666-0172
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-30
Last Update Date:2008-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX18999101YP2500X
TX4963106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional