Provider Demographics
NPI:1316346273
Name:FOLEN, REGINA VICTORIA (BAS)
Entity type:Individual
Prefix:
First Name:REGINA
Middle Name:VICTORIA
Last Name:FOLEN
Suffix:
Gender:F
Credentials:BAS
Other - Prefix:
Other - First Name:REGINA
Other - Middle Name:VICTORIA
Other - Last Name:FOLEN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 826
Mailing Address - Street 2:
Mailing Address - City:CRESCENT CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32112-0826
Mailing Address - Country:US
Mailing Address - Phone:386-546-5046
Mailing Address - Fax:888-686-1405
Practice Address - Street 1:405 S SUMMIT ST STE E
Practice Address - Street 2:
Practice Address - City:CRESCENT CITY
Practice Address - State:FL
Practice Address - Zip Code:32112
Practice Address - Country:US
Practice Address - Phone:904-803-1581
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-17
Last Update Date:2018-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL$$$$$$$$$OtherSELF ,SSN, FOR INDIVIDUAL NPI NUMBER