Healthcare Provider Details

I. General information

NPI: 1417315573
Provider Name (Legal Business Name): REGINA MCMASTER LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/04/2016
Last Update Date: 02/04/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 COMMERCIAL PL
NEWBURGH NY
12550-5306
US

IV. Provider business mailing address

2570 US HIGHWAY 9W SUITE 10
CORNWALL NY
12518-1323
US

V. Phone/Fax

Practice location:
  • Phone: 845-220-2146
  • Fax:
Mailing address:
  • Phone: 845-220-2146
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number094330
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: