MEDICARE: DR. REGINA MCKINNEY PSY.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	20042476A	IN
2	103TC0700X	Clinical Psychologist	6638	OH

General Provider Information

NPI Number	:	1740687763
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. REGINA MCKINNEY PSY.D.

Provider Business Mailing Address
First Line	:	1019 DELTA AVE
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45208-3103
Country	:	US
Telephone Number	:	513-871-7285
Fax Number	:

Provider Business Practice Location Address
First Line	:	1019 DELTA AVE
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45208-3103
Country	:	US
Telephone Number	:	513-871-7285
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/20/2014
Last Update Date	:	09/21/2015

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