Provider Demographics
NPI:1376867259
Name:REGO, STEVEN WILLIAM (LCSW)
Entity type:Individual
Prefix:
First Name:STEVEN
Middle Name:WILLIAM
Last Name:REGO
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:305 E HIGH ST
Mailing Address - Street 2:
Mailing Address - City:BOUND BROOK
Mailing Address - State:NJ
Mailing Address - Zip Code:08805-1975
Mailing Address - Country:US
Mailing Address - Phone:201-376-5898
Mailing Address - Fax:
Practice Address - Street 1:305 E HIGH ST
Practice Address - Street 2:
Practice Address - City:BOUND BROOK
Practice Address - State:NJ
Practice Address - Zip Code:08805-1975
Practice Address - Country:US
Practice Address - Phone:201-376-5898
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-20
Last Update Date:2012-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY079404104100000X
NJ44SC054977001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker