Healthcare Provider Details

I. General information

NPI: 1447179809
Provider Name (Legal Business Name): REGINE BEYENG MUTECK CLINICIAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/10/2026
Last Update Date: 07/10/2026
Certification Date: 07/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

971 MAIN ST
LANCASTER MA
01523-2569
US

IV. Provider business mailing address

7 VENDORA RD
WORCESTER MA
01606-3022
US

V. Phone/Fax

Practice location:
  • Phone: 978-368-6442
  • Fax:
Mailing address:
  • Phone: 774-242-7675
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: