Provider Demographics
NPI:1619120805
Name:VITALE-MERCADO, REGINA E (LCSW-R)
Entity Type:Individual
Prefix:
First Name:REGINA
Middle Name:E
Last Name:VITALE-MERCADO
Suffix:
Gender:F
Credentials:LCSW-R
Other - Prefix:
Other - First Name:REGINA
Other - Middle Name:
Other - Last Name:VITALE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:205 OAKVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:FARMINGDALE
Mailing Address - State:NY
Mailing Address - Zip Code:11735-3710
Mailing Address - Country:US
Mailing Address - Phone:917-655-3509
Mailing Address - Fax:
Practice Address - Street 1:205 OAKVIEW AVE
Practice Address - Street 2:
Practice Address - City:FARMINGDALE
Practice Address - State:NY
Practice Address - Zip Code:11735-3710
Practice Address - Country:US
Practice Address - Phone:917-655-3509
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-31
Last Update Date:2020-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0767021041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical