Provider Demographics
NPI:1336271717
Name:BUDESA, REGINA M (PSYD)
Entity Type:Individual
Prefix:
First Name:REGINA
Middle Name:M
Last Name:BUDESA
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:80 POMPTON AVE STE 301
Mailing Address - Street 2:
Mailing Address - City:VERONA
Mailing Address - State:NJ
Mailing Address - Zip Code:07044-2913
Mailing Address - Country:US
Mailing Address - Phone:973-897-7774
Mailing Address - Fax:
Practice Address - Street 1:80 POMPTON AVE STE 301
Practice Address - Street 2:
Practice Address - City:VERONA
Practice Address - State:NJ
Practice Address - Zip Code:07044-2913
Practice Address - Country:US
Practice Address - Phone:973-897-7774
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-12
Last Update Date:2019-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ4289103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist