Provider Demographics
NPI:1689048126
Name:MARTIN, REGINA M
Entity Type:Individual
Prefix:MRS
First Name:REGINA
Middle Name:M
Last Name:MARTIN
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:REGINA
Other - Middle Name:M
Other - Last Name:PEREZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2765 SEDGWICK AVE APT 4F
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10468-2448
Mailing Address - Country:US
Mailing Address - Phone:347-490-2610
Mailing Address - Fax:
Practice Address - Street 1:70-00 AUSTIN STREET
Practice Address - Street 2:ACHIEVE BEYOND SUITE 200
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375
Practice Address - Country:US
Practice Address - Phone:718-762-7633
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-11-20
Last Update Date:2015-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst