Healthcare Provider Details

I. General information

NPI: 1760470090
Provider Name (Legal Business Name): JOANNE M REGINA PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/11/2005
Last Update Date: 03/28/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

264 E BROAD ST
BETHLEHEM PA
18018-6224
US

IV. Provider business mailing address

3235 WITHEE CT
BETHLEHEM PA
18020-1338
US

V. Phone/Fax

Practice location:
  • Phone: 610-866-9311
  • Fax: 610-882-2072
Mailing address:
  • Phone: 484-239-8249
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPS005682L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: