Provider Demographics
NPI:1699845800
Name:REGO, SIMON A (PSYD, ABPP, ACT)
Entity Type:Individual
Prefix:DR
First Name:SIMON
Middle Name:A
Last Name:REGO
Suffix:
Gender:M
Credentials:PSYD, ABPP, ACT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 E 210TH ST
Mailing Address - Street 2:PSYCHIATRY
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10467-2401
Mailing Address - Country:US
Mailing Address - Phone:718-920-5024
Mailing Address - Fax:718-798-1816
Practice Address - Street 1:111 E 210TH ST
Practice Address - Street 2:PSYCHIATRY
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10467-2401
Practice Address - Country:US
Practice Address - Phone:718-920-5024
Practice Address - Fax:718-798-1816
Is Sole Proprietor?:No
Enumeration Date:2006-11-08
Last Update Date:2011-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY015781103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist