Provider Demographics
NPI:1598851370
Name:GERSTMAN, REGINA LEE (LCSW,PHD)
Entity Type:Individual
Prefix:MS
First Name:REGINA
Middle Name:LEE
Last Name:GERSTMAN
Suffix:
Gender:F
Credentials:LCSW,PHD
Other - Prefix:DR
Other - First Name:REGINA
Other - Middle Name:LEE
Other - Last Name:GERSTMAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:12725 MCMANUS BLVD
Mailing Address - Street 2:BLDG 2 SUITE G
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23602-4402
Mailing Address - Country:US
Mailing Address - Phone:757-874-1676
Mailing Address - Fax:757-874-2226
Practice Address - Street 1:US ROUTE 17
Practice Address - Street 2:ABINGDON OFFICE PARK SUITE 10
Practice Address - City:HAYES
Practice Address - State:VA
Practice Address - Zip Code:23072-1128
Practice Address - Country:US
Practice Address - Phone:804-642-3414
Practice Address - Fax:804-642-3632
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040047281041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA64402316OtherTRICARE
VA145188OtherANTHEM
VA005579T57Medicare ID - Type Unspecified
VA64402316OtherTRICARE