Provider Demographics
NPI:1760533178
Name:REGIS, SANDRA L (PHD)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:L
Last Name:REGIS
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 1:86 UNION ST
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:NY
Mailing Address - Zip Code:12549-1319
Mailing Address - Country:US
Mailing Address - Phone:845-457-9959
Mailing Address - Fax:
Practice Address - Street 1:19 HILL ST
Practice Address - Street 2:
Practice Address - City:GOSHEN
Practice Address - State:NY
Practice Address - Zip Code:10924-2113
Practice Address - Country:US
Practice Address - Phone:845-294-9139
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY11300103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist