Healthcare Provider Details

I. General information

NPI: 1598851370
Provider Name (Legal Business Name): REGINA LEE GERSTMAN LCSW,PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: REGINA LEE GERSTMAN PH.D.

II. Dates (important events)

Enumeration Date: 10/05/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

US ROUTE 17 ABINGDON OFFICE PARK SUITE 10
HAYES VA
23072-1128
US

IV. Provider business mailing address

12725 MCMANUS BLVD BLDG 2 SUITE G
NEWPORT NEWS VA
23602-4402
US

V. Phone/Fax

Practice location:
  • Phone: 804-642-3414
  • Fax: 804-642-3632
Mailing address:
  • Phone: 757-874-1676
  • Fax: 757-874-2226

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number0904004728
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: