Provider Demographics
NPI:1154194439
Name:NABOZNY, REGANNE
Entity type:Individual
Prefix:
First Name:REGANNE
Middle Name:
Last Name:NABOZNY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7371 EDINBOROUGH
Mailing Address - Street 2:
Mailing Address - City:WEST BLOOMFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48322-4032
Mailing Address - Country:US
Mailing Address - Phone:269-366-0410
Mailing Address - Fax:
Practice Address - Street 1:7459 MIDDLEBELT RD
Practice Address - Street 2:
Practice Address - City:WEST BLOOMFIELD
Practice Address - State:MI
Practice Address - Zip Code:48322-4184
Practice Address - Country:US
Practice Address - Phone:248-733-4899
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-30
Last Update Date:2023-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical