Provider Demographics
NPI:1679692289
Name:FLETCHER, REGINA ONGIONI (LCSW)
Entity Type:Individual
Prefix:MS
First Name:REGINA
Middle Name:ONGIONI
Last Name:FLETCHER
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 1:108 SOUTHERN BLVD
Mailing Address - Street 2:
Mailing Address - City:NESCONSET
Mailing Address - State:NY
Mailing Address - Zip Code:11767-1732
Mailing Address - Country:US
Mailing Address - Phone:631-724-3103
Mailing Address - Fax:
Practice Address - Street 1:9 BROOKSITE DR
Practice Address - Street 2:
Practice Address - City:SMITHTOWN
Practice Address - State:NY
Practice Address - Zip Code:11787-3400
Practice Address - Country:US
Practice Address - Phone:631-839-9072
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-28
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR061541-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYP3596105OtherOXFORD
NY546996OtherVALUE OPTIONS
NYNT1791Medicare UPIN
NYNT1791Medicare ID - Type Unspecified