Healthcare Provider Details

I. General information

NPI: 1235979816
Provider Name (Legal Business Name): REGINA TOPER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/30/2024
Last Update Date: 05/30/2024
Certification Date: 05/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 SE CENTRAL PKWY STE 100
STUART FL
34994-5914
US

IV. Provider business mailing address

10140 159TH CT N
JUPITER FL
33478-9351
US

V. Phone/Fax

Practice location:
  • Phone: 772-303-1103
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberIMH19242
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: