Provider Demographics
NPI:1760470090
Name:REGINA, JOANNE M (PHD)
Entity Type:Individual
Prefix:DR
First Name:JOANNE
Middle Name:M
Last Name:REGINA
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3235 WITHEE CT
Mailing Address - Street 2:
Mailing Address - City:BETHLEHEM
Mailing Address - State:PA
Mailing Address - Zip Code:18020-1338
Mailing Address - Country:US
Mailing Address - Phone:484-239-8249
Mailing Address - Fax:
Practice Address - Street 1:264 E BROAD ST
Practice Address - Street 2:
Practice Address - City:BETHLEHEM
Practice Address - State:PA
Practice Address - Zip Code:18018-6224
Practice Address - Country:US
Practice Address - Phone:610-866-9311
Practice Address - Fax:610-882-2072
Is Sole Proprietor?:No
Enumeration Date:2005-10-11
Last Update Date:2008-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS005682L103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA620272OtherHIGHMARK
PA01976801OtherCAPITAL BLUE CROSS
PA4357978OtherAETNA
PA01976801OtherCAPITAL BLUE CROSS
PAR07565Medicare UPIN