Healthcare Provider Details

I. General information

NPI: 1821533167
Provider Name (Legal Business Name): REGINA KAM LCSW-R
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/22/2016
Last Update Date: 12/22/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

140 SUFFOLK AVE PH
STATEN ISLAND NY
10314-5173
US

IV. Provider business mailing address

140 SUFFOLK AVE PH
STATEN ISLAND NY
10314-5173
US

V. Phone/Fax

Practice location:
  • Phone: 718-986-9590
  • Fax:
Mailing address:
  • Phone: 718-986-9590
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberR041037-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: