Provider Demographics
NPI:1841604691
Name:ROSS, REGINA D (LCSW-R)
Entity Type:Individual
Prefix:
First Name:REGINA
Middle Name:D
Last Name:ROSS
Suffix:
Gender:F
Credentials:LCSW-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:140 CASALS PL
Mailing Address - Street 2:14H
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10475-3202
Mailing Address - Country:US
Mailing Address - Phone:347-912-0900
Mailing Address - Fax:
Practice Address - Street 1:140 CASALS PL
Practice Address - Street 2:14H
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10475-3202
Practice Address - Country:US
Practice Address - Phone:347-912-0900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-19
Last Update Date:2015-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0511221041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA300116606Medicare PIN