Provider Demographics
NPI:1891478608
Name:REGINA, ANDREA (LICSW, M ED)
Entity Type:Individual
Prefix:MS
First Name:ANDREA
Middle Name:
Last Name:REGINA
Suffix:
Gender:F
Credentials:LICSW, M ED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:668 MAIN ST # 194
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:01887-3395
Mailing Address - Country:US
Mailing Address - Phone:978-435-3727
Mailing Address - Fax:
Practice Address - Street 1:108 QUINCY RD
Practice Address - Street 2:
Practice Address - City:TEWKSBURY
Practice Address - State:MA
Practice Address - Zip Code:01876-1422
Practice Address - Country:US
Practice Address - Phone:978-618-7103
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-09
Last Update Date:2023-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1259041041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical