1497170724 NPI number — MRS. ELIZABETH ANASTASIA REGINA-DANIELS LMSW

Table of content: MRS. ELIZABETH ANASTASIA REGINA-DANIELS LMSW (NPI 1497170724)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1497170724 NPI number — MRS. ELIZABETH ANASTASIA REGINA-DANIELS LMSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
REGINA-DANIELS
Provider First Name:
ELIZABETH
Provider Middle Name:
ANASTASIA
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LMSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
REGINA
Provider Other First Name:
ELIZABETH
Provider Other Middle Name:
ANASTASIA
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
LMSW
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1497170724
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/24/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
39 WYLDE RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MOUNT SINAI
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11766-2403
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
631-560-5434
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2233 NESCONSET HWY
Provider Second Line Business Practice Location Address:
STE 104
Provider Business Practice Location Address City Name:
LAKE GROVE
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11755-1000
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
631-737-5559
Provider Business Practice Location Address Fax Number:
631-737-0001
Provider Enumeration Date:
02/24/2014

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: 104100000X , with the licence number:  082056-1 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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