Provider Demographics
NPI:1376390278
Name:REGENSBURG INTEGRATIVE PSYCHOTHERAPY LCSW PC
Entity type:Organization
Organization Name:REGENSBURG INTEGRATIVE PSYCHOTHERAPY LCSW PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:SHARMAN
Authorized Official - Middle Name:
Authorized Official - Last Name:REGENSBURG
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:631-848-7839
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:631-493-0046
Mailing Address - Fax:631-493-0046
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:631-493-0046
Practice Address - Fax:631-493-0046
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-30
Last Update Date:2024-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty