Healthcare Provider Details

I. General information

NPI: 1568792448
Provider Name (Legal Business Name): DR. REGINA LEGERE-BUCCELLATO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: DR. REGINA LEGERE

II. Dates (important events)

Enumeration Date: 12/28/2009
Last Update Date: 12/28/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1545 ATLANTIC AVE
BROOKLYN NY
11213-1122
US

IV. Provider business mailing address

5068 44TH ST
WOODSIDE NY
11377-7320
US

V. Phone/Fax

Practice location:
  • Phone: 718-613-4471
  • Fax:
Mailing address:
  • Phone: 718-482-8547
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: