Provider Demographics
NPI:1982160305
Name:REGALBUTO, MARIE
Entity Type:Individual
Prefix:
First Name:MARIE
Middle Name:
Last Name:REGALBUTO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2810 COLISEUM CENTRE DR STE 520
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28217-3345
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:000-000-0000
Practice Address - Street 1:2810 COLISEUM CENTRE DR STE 520
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28217-3345
Practice Address - Country:US
Practice Address - Phone:980-785-1113
Practice Address - Fax:000-000-0000
Is Sole Proprietor?:No
Enumeration Date:2019-02-11
Last Update Date:2024-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC152103K00000X
103K00000X
NY1-18-33806103K00000X
NC1-18-33806103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst