Basic Information
| Provider Information | |||||||||
| NPI: | 1790892545 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ENGLADE | ||||||||
| FirstName: | REGINA | ||||||||
| MiddleName: | DALUNE | ||||||||
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| Credential: | LICSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 147 PEABODY ST | ||||||||
| Address2: | |||||||||
| City: | GROTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 014501817 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9784485540 | ||||||||
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| Practice Location | |||||||||
| Address1: | 100 ERDMAN WAY | ||||||||
| Address2: | |||||||||
| City: | LEOMINSTER | ||||||||
| State: | MA | ||||||||
| PostalCode: | 01453 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9784668349 | ||||||||
| FaxNumber: | 9785376174 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/25/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 104541 | MA | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.