Provider Demographics
NPI:1750407565
Name:DEASE, REGINA E (BSE)
Entity type:Individual
Prefix:MRS
First Name:REGINA
Middle Name:E
Last Name:DEASE
Suffix:
Gender:F
Credentials:BSE
Other - Prefix:MS
Other - First Name:REGINA
Other - Middle Name:ELAINE
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7546 BROCKTON RD
Mailing Address - Street 2:
Mailing Address - City:PHILA
Mailing Address - State:PA
Mailing Address - Zip Code:19151-2825
Mailing Address - Country:US
Mailing Address - Phone:215-203-2990
Mailing Address - Fax:
Practice Address - Street 1:112 N BROAD ST
Practice Address - Street 2:
Practice Address - City:PHILA
Practice Address - State:PA
Practice Address - Zip Code:19102-1510
Practice Address - Country:US
Practice Address - Phone:215-568-0860
Practice Address - Fax:215-568-0769
Is Sole Proprietor?:No
Enumeration Date:2007-03-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor