MEDICARE: REGINA SMITH

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	222Q00000X	Developmental Therapist
2	235Z00000X	Speech-Language Pathologist
3	235Z00000X	Speech-Language Pathologist	41YS00998900	NJ

General Provider Information

NPI Number	:	1932514809
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	REGINA SMITH

Provider Business Mailing Address
First Line	:	18-20 LACKAWANNA PLZ STE 300
Second Line	:
City	:	MONTCLAIR
State	:	NJ
Zip	:	07042-3642
Country	:	US
Telephone Number	:	973-826-0595
Fax Number	:

Provider Business Practice Location Address
First Line	:	18-20 LACKAWANNA PLZ STE 300
Second Line	:
City	:	MONTCLAIR
State	:	NJ
Zip	:	07042-3642
Country	:	US
Telephone Number	:	973-826-0595
Fax Number	:

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

Provider Enumeration Date	:	06/30/2014
Last Update Date	:	04/27/2025

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Directions to “ REGINA SMITH ” Practice Location

Language	Start Address	Practice Location

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