Provider Demographics
NPI:1568422897
Name:NELSON, REGINAL GENE (PSY)
Entity Type:Individual
Prefix:MR
First Name:REGINAL
Middle Name:GENE
Last Name:NELSON
Suffix:
Gender:M
Credentials:PSY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:413 HILLSIDE RD
Mailing Address - Street 2:
Mailing Address - City:KING OF PRUSSIA
Mailing Address - State:PA
Mailing Address - Zip Code:19406-3127
Mailing Address - Country:US
Mailing Address - Phone:610-313-8866
Mailing Address - Fax:610-323-1406
Practice Address - Street 1:634 KING ST
Practice Address - Street 2:
Practice Address - City:POTTSTOWN
Practice Address - State:PA
Practice Address - Zip Code:19464-5743
Practice Address - Country:US
Practice Address - Phone:610-323-8866
Practice Address - Fax:610-323-1406
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS015506103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist