Provider Demographics
NPI:1841503208
Name:CAMILLIERI, REGINA LYNN (BSW,IBCLC)
Entity type:Individual
Prefix:
First Name:REGINA
Middle Name:LYNN
Last Name:CAMILLIERI
Suffix:
Gender:F
Credentials:BSW,IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1983 CROMPOND RD
Mailing Address - Street 2:
Mailing Address - City:CORTLANDT MANOR
Mailing Address - State:NY
Mailing Address - Zip Code:10567-4121
Mailing Address - Country:US
Mailing Address - Phone:845-337-0141
Mailing Address - Fax:
Practice Address - Street 1:1241 MAMARONECK AVE
Practice Address - Street 2:
Practice Address - City:WHITE PLAINS
Practice Address - State:NY
Practice Address - Zip Code:10605-5201
Practice Address - Country:US
Practice Address - Phone:914-421-1500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-14
Last Update Date:2022-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002025106H00000X
NC198-14501174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1841503208OtherHEALTH INSURANCE