Provider Demographics
NPI:1972365575
Name:SHAWLEY, REGINA LOUISE
Entity type:Individual
Prefix:
First Name:REGINA
Middle Name:LOUISE
Last Name:SHAWLEY
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 1:140 W PENN AVE STE 2
Mailing Address - Street 2:
Mailing Address - City:ROBESONIA
Mailing Address - State:PA
Mailing Address - Zip Code:19551-1504
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:140 W PENN AVE STE 2
Practice Address - Street 2:
Practice Address - City:ROBESONIA
Practice Address - State:PA
Practice Address - Zip Code:19551-1504
Practice Address - Country:US
Practice Address - Phone:610-750-9135
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-29
Last Update Date:2024-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC016306101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional