Provider Demographics
NPI:1992254122
Name:DURSO, REGINA (LCSW-C)
Entity type:Individual
Prefix:
First Name:REGINA
Middle Name:
Last Name:DURSO
Suffix:
Gender:F
Credentials:LCSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:802 LLEWELLYN MANOR DR
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20905-3817
Mailing Address - Country:US
Mailing Address - Phone:301-924-1029
Mailing Address - Fax:
Practice Address - Street 1:5570 STERRETT PL
Practice Address - Street 2:SUITE 206
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21044-2641
Practice Address - Country:US
Practice Address - Phone:410-884-6031
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-29
Last Update Date:2016-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD056741041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical