Provider Demographics
NPI:1538231279
Name:PACKARD, REGINA F (LCSW)
Entity type:Individual
Prefix:MS
First Name:REGINA
Middle Name:F
Last Name:PACKARD
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1593 HIGH FALLS RD
Mailing Address - Street 2:
Mailing Address - City:CATSKILL
Mailing Address - State:NY
Mailing Address - Zip Code:12414-5643
Mailing Address - Country:US
Mailing Address - Phone:518-678-9932
Mailing Address - Fax:
Practice Address - Street 1:465 BROADWAY
Practice Address - Street 2:
Practice Address - City:KINGSTON
Practice Address - State:NY
Practice Address - Zip Code:12401-4627
Practice Address - Country:US
Practice Address - Phone:845-340-0244
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-15
Last Update Date:2014-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR042945-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA400105164Medicare PIN
NYNS5391Medicare ID - Type UnspecifiedSOCIAL WORK