Provider Demographics
NPI:1073235321
Name:REGO-MEDEIROS, ELIZABETHE M (MSW, LICSW)
Entity type:Individual
Prefix:
First Name:ELIZABETHE
Middle Name:M
Last Name:REGO-MEDEIROS
Suffix:
Gender:F
Credentials:MSW, LICSW
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:M
Other - Last Name:REGO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW,LCSW
Mailing Address - Street 1:233 CAROLINE ST
Mailing Address - Street 2:
Mailing Address - City:NEW BEDFORD
Mailing Address - State:MA
Mailing Address - Zip Code:02740-4625
Mailing Address - Country:US
Mailing Address - Phone:508-274-9815
Mailing Address - Fax:
Practice Address - Street 1:277 PLEASANT ST STE 437
Practice Address - Street 2:
Practice Address - City:FALL RIVER
Practice Address - State:MA
Practice Address - Zip Code:02721-3005
Practice Address - Country:US
Practice Address - Phone:774-301-8315
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-14
Last Update Date:2025-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1286721041C0700X
MA226849101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health