Provider Demographics
NPI:1912039264
Name:OMOSEBI, REGINA ADETORO (MA PSYCHOLOGIST)
Entity type:Individual
Prefix:MRS
First Name:REGINA
Middle Name:ADETORO
Last Name:OMOSEBI
Suffix:
Gender:F
Credentials:MA PSYCHOLOGIST
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Mailing Address - Street 1:46 COMMONWEALTH AVE
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:NY
Mailing Address - Zip Code:10940
Mailing Address - Country:US
Mailing Address - Phone:646-234-4140
Mailing Address - Fax:845-467-4536
Practice Address - Street 1:46 COMMONWEALTH AVE
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:NY
Practice Address - Zip Code:10940
Practice Address - Country:US
Practice Address - Phone:646-234-4140
Practice Address - Fax:845-467-4536
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-12
Last Update Date:2012-02-15
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TM1800XBehavioral Health & Social Service ProvidersPsychologistIntellectual & Developmental Disabilities