Provider Demographics
NPI:1194007484
Name:BURNETTE, REGINA RENEA
Entity type:Individual
Prefix:MISS
First Name:REGINA
Middle Name:RENEA
Last Name:BURNETTE
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 1:6117 MLK JR. WAY
Mailing Address - Street 2:THERAPEUTIC NURSERY SCHOOL
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94609
Mailing Address - Country:US
Mailing Address - Phone:510-655-4896
Mailing Address - Fax:510-658-7140
Practice Address - Street 1:6117 MLK JR WAY
Practice Address - Street 2:THERAPEUTIC NURSERY SCHOOL
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94609-1240
Practice Address - Country:US
Practice Address - Phone:510-655-4896
Practice Address - Fax:510-658-7140
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-13
Last Update Date:2024-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1104191041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical