Provider Demographics
NPI:1982024485
Name:MAJESTRO, REGINA (BA)
Entity Type:Individual
Prefix:MS
First Name:REGINA
Middle Name:
Last Name:MAJESTRO
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1311 N DIXIE HWY
Mailing Address - Street 2:
Mailing Address - City:ELIZABETHTOWN
Mailing Address - State:KY
Mailing Address - Zip Code:42701-2621
Mailing Address - Country:US
Mailing Address - Phone:270-769-1304
Mailing Address - Fax:
Practice Address - Street 1:1072 S DIXIE BLVD
Practice Address - Street 2:
Practice Address - City:RADCLIFF
Practice Address - State:KY
Practice Address - Zip Code:40160-1103
Practice Address - Country:US
Practice Address - Phone:270-351-8166
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-04-23
Last Update Date:2014-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor