Healthcare Provider Details

I. General information

NPI: 1831505114
Provider Name (Legal Business Name): REGINA E. FITCH LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2014
Last Update Date: 04/28/2020
Certification Date: 04/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

155 CHESTNUT ST
NUTLEY NJ
07110-2311
US

IV. Provider business mailing address

368 BROAD ST APT 317
NEWARK NJ
07104-3870
US

V. Phone/Fax

Practice location:
  • Phone: 973-667-1884
  • Fax:
Mailing address:
  • Phone: 973-981-5746
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number919482
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number44SC05890200
License Number StateNJ

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: