Healthcare Provider Details

I. General information

NPI: 1629065313
Provider Name (Legal Business Name): ROSEMARY O'REGAN-PERRETTA PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 09/29/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

170 REGENT DR
LIDO BEACH NY
11561-4935
US

IV. Provider business mailing address

170 REGENT DR
LIDO BEACH NY
11561-4935
US

V. Phone/Fax

Practice location:
  • Phone: 516-432-5277
  • Fax:
Mailing address:
  • Phone: 516-432-5277
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number012101-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: