1053471763 NPI number — DR. REGINA LEIGH KUECKS-MORGAN PH.D.

Table of content: DR. REGINA LEIGH KUECKS-MORGAN PH.D. (NPI 1053471763)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1053471763 NPI number — DR. REGINA LEIGH KUECKS-MORGAN PH.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KUECKS-MORGAN
Provider First Name:
REGINA
Provider Middle Name:
LEIGH
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PH.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1053471763
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
32 BELAIR AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PROVIDENCE
Provider Business Mailing Address State Name:
RI
Provider Business Mailing Address Postal Code:
02906-2411
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
401-861-5085
Provider Business Mailing Address Fax Number:
401-751-1005

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
295 ANGELL ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PROVIDENCE
Provider Business Practice Location Address State Name:
RI
Provider Business Practice Location Address Postal Code:
02906-2119
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
401-751-1005
Provider Business Practice Location Address Fax Number:
401-751-1005
Provider Enumeration Date:
12/11/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 103TC0700X , with the licence number:  PS00773 , registered in the state of RI ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 103TC2200X , with the licence number: PS00773 , registered in the state of RI ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 26429-5 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
  • Identifier: 210158 . This is a "UNITED BEHAVIORAL HEALTH" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
  • Identifier: RK56885 , issued by the state of ( RI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1040290 . This is a "BEACON NEIGHBORHOOD HEALT" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".




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