Provider Demographics
NPI:1750491676
Name:FERRERA, REGINA MARIE (MSW LCSW)
Entity Type:Individual
Prefix:MS
First Name:REGINA
Middle Name:MARIE
Last Name:FERRERA
Suffix:
Gender:F
Credentials:MSW LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1430 S AUSTIN
Mailing Address - Street 2:1 F
Mailing Address - City:CICERO
Mailing Address - State:IL
Mailing Address - Zip Code:60804-1058
Mailing Address - Country:US
Mailing Address - Phone:708-780-1214
Mailing Address - Fax:708-780-1214
Practice Address - Street 1:1430 S AUSTIN
Practice Address - Street 2:1 F
Practice Address - City:CICERO
Practice Address - State:IL
Practice Address - Zip Code:60804-1058
Practice Address - Country:US
Practice Address - Phone:708-780-1214
Practice Address - Fax:708-780-1214
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL01633789OtherBLUE CROSS BLUE SHIELD