Provider Demographics
NPI:1790933489
Name:STREETER JOHNSON, REGINA S (LMSW)
Entity Type:Individual
Prefix:
First Name:REGINA
Middle Name:S
Last Name:STREETER JOHNSON
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:REGINA
Other - Middle Name:S
Other - Last Name:STREETER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:13028 176TH PL
Mailing Address - Street 2:
Mailing Address - City:JAMAICA
Mailing Address - State:NY
Mailing Address - Zip Code:11434-5850
Mailing Address - Country:US
Mailing Address - Phone:718-498-4100
Mailing Address - Fax:
Practice Address - Street 1:796H DREW ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11208-4704
Practice Address - Country:US
Practice Address - Phone:718-235-3100
Practice Address - Fax:718-277-0822
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-05
Last Update Date:2008-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0707331104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker