Healthcare Provider Details

I. General information

NPI: 1902038151
Provider Name (Legal Business Name): REGINA MARIE FRUGE LISW-I
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/20/2009
Last Update Date: 08/20/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1180 E MAIN ST
COLUMBUS OH
43205-1902
US

IV. Provider business mailing address

600 W SPRING ST REAR 2
COLUMBUS OH
43215-2374
US

V. Phone/Fax

Practice location:
  • Phone: 614-645-5535
  • Fax: 614-645-5546
Mailing address:
  • Phone: 614-645-5500
  • Fax: 614-645-5517

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberI.090066
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: