Basic Information
| Provider Information | |||||||||
| NPI: | 1447337589 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HEARN | ||||||||
| FirstName: | REGINA | ||||||||
| MiddleName: | ANNE | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | LCSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 23501 CINEMA DR STE 210 | ||||||||
| Address2: | |||||||||
| City: | VALENCIA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 913555430 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6612884804 | ||||||||
| FaxNumber: | 6612543094 | ||||||||
| Practice Location | |||||||||
| Address1: | 23501 CINEMA DR STE 210 | ||||||||
| Address2: | |||||||||
| City: | VALENCIA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 913555430 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6612884804 | ||||||||
| FaxNumber: | 6612543094 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/01/2006 | ||||||||
| LastUpdateDate: | 04/14/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 26806 | CA | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
ID Information
| ID | Type | State | Issuer | Description | 7610 | 05 | CA | MEDICAID |