Healthcare Provider Details

I. General information

NPI: 1992883102
Provider Name (Legal Business Name): PATRICIA REGUCCI L.C.S.W.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/02/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

48 GEORGE ST
HARRINGTON PARK NJ
07640-1414
US

IV. Provider business mailing address

48 GEORGE ST
HARRINGTON PARK NJ
07640-1414
US

V. Phone/Fax

Practice location:
  • Phone: 201-768-6661
  • Fax: 201-768-6666
Mailing address:
  • Phone: 201-768-6661
  • Fax: 201-768-6666

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number44SC00447800
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: