Provider Demographics
NPI:1295800241
Name:PHILLIPS, REGINA E (LCSW)
Entity type:Individual
Prefix:MS
First Name:REGINA
Middle Name:E
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:987 OLD EAGLE SCHOOL RD
Mailing Address - Street 2:STE 719
Mailing Address - City:WAYNE
Mailing Address - State:PA
Mailing Address - Zip Code:19087
Mailing Address - Country:US
Mailing Address - Phone:610-668-9304
Mailing Address - Fax:610-971-0144
Practice Address - Street 1:987 OLD EAGLE SCHOOL RD
Practice Address - Street 2:STE 719
Practice Address - City:WAYNE
Practice Address - State:PA
Practice Address - Zip Code:19087
Practice Address - Country:US
Practice Address - Phone:610-668-9304
Practice Address - Fax:610-971-0144
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-22
Last Update Date:2010-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0123351041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA534182Medicare ID - Type Unspecified