Provider Demographics
NPI:1598196693
Name:GORMAN, REGINA (LCSW)
Entity Type:Individual
Prefix:
First Name:REGINA
Middle Name:
Last Name:GORMAN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:90 EUSTON RD S
Mailing Address - Street 2:
Mailing Address - City:WEST HEMPSTEAD
Mailing Address - State:NY
Mailing Address - Zip Code:11552-1004
Mailing Address - Country:US
Mailing Address - Phone:516-712-4193
Mailing Address - Fax:
Practice Address - Street 1:90 EUSTON RD S
Practice Address - Street 2:
Practice Address - City:WEST HEMPSTEAD
Practice Address - State:NY
Practice Address - Zip Code:11552-1004
Practice Address - Country:US
Practice Address - Phone:516-712-4193
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-29
Last Update Date:2013-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY081101104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker