Provider Demographics
NPI:1780929588
Name:JAMIESON, REGINA (LICSW)
Entity type:Individual
Prefix:
First Name:REGINA
Middle Name:
Last Name:JAMIESON
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:160 BOYLSTON ST
Mailing Address - Street 2:APT 1205
Mailing Address - City:CHESTNUT HILL
Mailing Address - State:MA
Mailing Address - Zip Code:02467-2021
Mailing Address - Country:US
Mailing Address - Phone:617-794-9648
Mailing Address - Fax:
Practice Address - Street 1:57 BEDFORD ST
Practice Address - Street 2:STE 125
Practice Address - City:LEXINGTON
Practice Address - State:MA
Practice Address - Zip Code:02420-4543
Practice Address - Country:US
Practice Address - Phone:781-861-1818
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-05
Last Update Date:2018-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1117241041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical