Provider Demographics
NPI:1881817054
Name:BREGMAN, LOIS A
Entity Type:Individual
Prefix:
First Name:LOIS
Middle Name:A
Last Name:BREGMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 BREAKWATER DR
Mailing Address - Street 2:
Mailing Address - City:CORONA DEL MAR
Mailing Address - State:CA
Mailing Address - Zip Code:92625-1415
Mailing Address - Country:US
Mailing Address - Phone:949-760-1707
Mailing Address - Fax:
Practice Address - Street 1:1400 QUAIL ST
Practice Address - Street 2:SUITE 235
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-2730
Practice Address - Country:US
Practice Address - Phone:949-261-6330
Practice Address - Fax:949-724-9005
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCSW121971041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical