Provider Demographics
NPI:1760461586
Name:TRAMMEL, REGINA CAROL (LCSW)
Entity Type:Individual
Prefix:DR
First Name:REGINA
Middle Name:CAROL
Last Name:TRAMMEL
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 1:147 W ROUTE 66
Mailing Address - Street 2:
Mailing Address - City:GLENDORA
Mailing Address - State:CA
Mailing Address - Zip Code:91740-6208
Mailing Address - Country:US
Mailing Address - Phone:626-765-7602
Mailing Address - Fax:
Practice Address - Street 1:147 W ROUTE 66
Practice Address - Street 2:PMB#1010
Practice Address - City:GLENDORA
Practice Address - State:CA
Practice Address - Zip Code:91740-6208
Practice Address - Country:US
Practice Address - Phone:626-765-7602
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-10
Last Update Date:2021-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA977221041C0700X
IL1490106911041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL2232829OtherBLUE CROSS BLUE SHEILD