Healthcare Provider Details

I. General information

NPI: 1073235321
Provider Name (Legal Business Name): ELIZABETHE M REGO-MEDEIROS MSW, LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ELIZABETH M. REGO MSW,LCSW

II. Dates (important events)

Enumeration Date: 09/14/2022
Last Update Date: 01/15/2025
Certification Date: 01/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

277 PLEASANT ST STE 437
FALL RIVER MA
02721-3005
US

IV. Provider business mailing address

233 CAROLINE ST
NEW BEDFORD MA
02740-4625
US

V. Phone/Fax

Practice location:
  • Phone: 774-301-8315
  • Fax:
Mailing address:
  • Phone: 508-274-9815
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number128672
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number226849
License Number StateMA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: