Provider Demographics
NPI:1730291253
Name:KELLY-SCURRY, REGINA ROSANWALDE (PHD)
Entity Type:Individual
Prefix:DR
First Name:REGINA
Middle Name:ROSANWALDE
Last Name:KELLY-SCURRY
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Gender:F
Credentials:PHD
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Mailing Address - Street 1:5599 N DIXIE HWY
Mailing Address - Street 2:OAKLAND PARK VETERANS ADMINISTRATION CLINIC
Mailing Address - City:OAKLAND PARK
Mailing Address - State:FL
Mailing Address - Zip Code:33334-3296
Mailing Address - Country:US
Mailing Address - Phone:954-229-7735
Mailing Address - Fax:954-229-7734
Practice Address - Street 1:5599 N DIXIE HWY
Practice Address - Street 2:OAKLAND PARK VETERANS ADMINISTRATION CLINIC
Practice Address - City:OAKLAND PARK
Practice Address - State:FL
Practice Address - Zip Code:33334-3296
Practice Address - Country:US
Practice Address - Phone:954-229-7735
Practice Address - Fax:954-229-7734
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLPY3738103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical