Provider Demographics
NPI:1770126070
Name:FAMIGLIETTI, REGINA YVETTE (MS, LMFT)
Entity type:Individual
Prefix:
First Name:REGINA
Middle Name:YVETTE
Last Name:FAMIGLIETTI
Suffix:
Gender:F
Credentials:MS, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15427 SHARON AVE
Mailing Address - Street 2:
Mailing Address - City:FONTANA
Mailing Address - State:CA
Mailing Address - Zip Code:92336-4429
Mailing Address - Country:US
Mailing Address - Phone:909-728-3858
Mailing Address - Fax:
Practice Address - Street 1:9033 BASELINE RD STE K
Practice Address - Street 2:
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91730-1214
Practice Address - Country:US
Practice Address - Phone:909-728-3858
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-21
Last Update Date:2019-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA114475106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist