Provider Demographics
NPI:1215345814
Name:REGINA M. BUDESA, PSYD, LIMITED LIABILITY COMPANY
Entity type:Organization
Organization Name:REGINA M. BUDESA, PSYD, LIMITED LIABILITY COMPANY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:REGINA
Authorized Official - Middle Name:M
Authorized Official - Last Name:BUDESA
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:973-897-7774
Mailing Address - Street 1:280 BLOOMFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:VERONA
Mailing Address - State:NJ
Mailing Address - Zip Code:07044-2426
Mailing Address - Country:US
Mailing Address - Phone:973-897-7774
Mailing Address - Fax:
Practice Address - Street 1:280 BLOOMFIELD AVE
Practice Address - Street 2:
Practice Address - City:VERONA
Practice Address - State:NJ
Practice Address - Zip Code:07044-2426
Practice Address - Country:US
Practice Address - Phone:973-897-7774
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-27
Last Update Date:2014-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ35S100428900103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty