Provider Demographics
NPI:1568792448
Name:LEGERE-BUCCELLATO, REGINA
Entity Type:Individual
Prefix:DR
First Name:REGINA
Middle Name:
Last Name:LEGERE-BUCCELLATO
Suffix:
Gender:F
Credentials:
Other - Prefix:DR
Other - First Name:REGINA
Other - Middle Name:
Other - Last Name:LEGERE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:5068 44TH ST
Mailing Address - Street 2:
Mailing Address - City:WOODSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11377-7320
Mailing Address - Country:US
Mailing Address - Phone:718-482-8547
Mailing Address - Fax:
Practice Address - Street 1:1545 ATLANTIC AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11213-1122
Practice Address - Country:US
Practice Address - Phone:718-613-4471
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-28
Last Update Date:2009-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist