Healthcare Provider Details

I. General information

NPI: 1801643440
Provider Name (Legal Business Name): ERIN ELIZABETH REGA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/01/2024
Last Update Date: 07/21/2026
Certification Date: 07/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

883 E MAIN ST
RIVERHEAD NY
11901-2613
US

IV. Provider business mailing address

51 RIDGE RD
ROCKY POINT NY
11778-8835
US

V. Phone/Fax

Practice location:
  • Phone: 631-650-2510
  • Fax:
Mailing address:
  • Phone: 631-456-2012
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number094250
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: