Provider Demographics
NPI:1255450300
Name:REGENSBURG, EDWARD A (LCAT)
Entity type:Individual
Prefix:MR
First Name:EDWARD
Middle Name:A
Last Name:REGENSBURG
Suffix:
Gender:M
Credentials:LCAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:37 WILLOUGHBY PATH
Mailing Address - Street 2:
Mailing Address - City:EAST NORTHPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11731-6329
Mailing Address - Country:US
Mailing Address - Phone:631-493-0933
Mailing Address - Fax:
Practice Address - Street 1:37 WILLOUGHBY PATH
Practice Address - Street 2:
Practice Address - City:EAST NORTHPORT
Practice Address - State:NY
Practice Address - Zip Code:11731-6329
Practice Address - Country:US
Practice Address - Phone:631-493-0933
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000152101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health