Healthcare Provider Details

I. General information

NPI: 1982949178
Provider Name (Legal Business Name): REGINA NEWTON LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/29/2012
Last Update Date: 06/08/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2858 W DIVERSEY AVE
CHICAGO IL
60647-1871
US

IV. Provider business mailing address

2010 N SPAULDING AVE UNIT 2
CHICAGO IL
60647-3736
US

V. Phone/Fax

Practice location:
  • Phone: 773-599-3417
  • Fax:
Mailing address:
  • Phone: 773-599-3417
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number149015812
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: