Provider Demographics
NPI:1053552422
Name:REGAL, KATHERINE PATTON (LICSW)
Entity type:Individual
Prefix:MS
First Name:KATHERINE
Middle Name:PATTON
Last Name:REGAL
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:MS
Other - First Name:KATHERINE
Other - Middle Name:A
Other - Last Name:PATTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LICSW
Mailing Address - Street 1:PO BOX 390835
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02139-0024
Mailing Address - Country:US
Mailing Address - Phone:617-905-9339
Mailing Address - Fax:617-292-9272
Practice Address - Street 1:675 MASSACHUSETTS AVE
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02139-3309
Practice Address - Country:US
Practice Address - Phone:617-682-5804
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-16
Last Update Date:2009-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1120751041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical