Provider Demographics
NPI:1760541577
Name:DUBS, REGINA PALMER (LCSW)
Entity Type:Individual
Prefix:MS
First Name:REGINA
Middle Name:PALMER
Last Name:DUBS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13901 US HIGHWAY 1
Mailing Address - Street 2:SUITE 11
Mailing Address - City:JUNO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33408-1612
Mailing Address - Country:US
Mailing Address - Phone:561-351-6441
Mailing Address - Fax:561-624-4772
Practice Address - Street 1:13901 US HIGHWAY 1
Practice Address - Street 2:SUITE 11
Practice Address - City:JUNO BEACH
Practice Address - State:FL
Practice Address - Zip Code:33408-1612
Practice Address - Country:US
Practice Address - Phone:561-351-6441
Practice Address - Fax:561-624-4772
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-07
Last Update Date:2015-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW17411041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
11656831OtherCAQH PROVIDER NUMBER
FLDS941AMedicare UPIN