Healthcare Provider Details

I. General information

NPI: 1538093984
Provider Name (Legal Business Name): MARINA REGO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2026
Last Update Date: 06/10/2026
Certification Date: 06/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

170 PLEASANT ST
FALL RIVER MA
02721-3015
US

IV. Provider business mailing address

25 BLUEBERRY DR
ACUSHNET MA
02743-1741
US

V. Phone/Fax

Practice location:
  • Phone: 774-294-5722
  • Fax:
Mailing address:
  • Phone: 508-525-0251
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: