Provider Demographics
NPI:1669129656
Name:ROSARIO, REGINA (MA)
Entity type:Individual
Prefix:MRS
First Name:REGINA
Middle Name:
Last Name:ROSARIO
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4065 CANE RIDGE PKWY STE 126C
Mailing Address - Street 2:
Mailing Address - City:ANTIOCH
Mailing Address - State:TN
Mailing Address - Zip Code:37013-5178
Mailing Address - Country:US
Mailing Address - Phone:615-228-2381
Mailing Address - Fax:
Practice Address - Street 1:4065 CANE RIDGE PKWY STE 126C
Practice Address - Street 2:
Practice Address - City:ANTIOCH
Practice Address - State:TN
Practice Address - Zip Code:37013-5178
Practice Address - Country:US
Practice Address - Phone:615-228-2381
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-09
Last Update Date:2024-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health