Provider Demographics
NPI:1558850099
Name:BREWINGTON, REGINA
Entity Type:Individual
Prefix:
First Name:REGINA
Middle Name:
Last Name:BREWINGTON
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 1:246 CORNELIA ST APT C10
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11221-5383
Mailing Address - Country:US
Mailing Address - Phone:718-781-4768
Mailing Address - Fax:
Practice Address - Street 1:246 CORNELIA ST APT C10
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11221-5383
Practice Address - Country:US
Practice Address - Phone:718-781-4768
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-09
Last Update Date:2018-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY103K00000X
103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst