Regina Joanna Peacock, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

98303 Issued in CA

Practice address

5822 Olive Ave
Rialto, CA 92377-3964

Phone

(909) 831-0446

NPI assigned

Dec 1, 2020

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other names 1

• Miss Regina J Peacock Former name

Medicare fee-for-service enrollment

Enrolled in CA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Healthy Mind & Brain Center Licensed Clinical Social Worker in.

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  • Apple Valley, CA
  • NPI 1255967063
  Medicare reassignment NPD Authorized official
• Sud Specialty Group - Ca

  • Addiction Medicine (Psychiatry & Neurology) Physician
  • Santa Clara, CA
  • NPI 1972138238

  Clinical

  Medicare reassignment NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1606780800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1628121600000",
    "number": "1053916965",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "16195 SISKIYOU RD STE 120B",
            "city": "APPLE VALLEY",
            "state": "CA",
            "postal_code": "923071346",
            "telephone_number": "760-646-9766",
            "fax_number": "760-646-9765"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5822 OLIVE AVE",
            "city": "RIALTO",
            "state": "CA",
            "postal_code": "923773964",
            "telephone_number": "909-831-0446"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PEACOCK",
        "first_name": "REGINA",
        "middle_name": "JOANNA",
        "name_prefix": "Miss",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-12-01",
        "last_updated": "2021-08-05",
        "certification_date": "2021-08-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "CA",
            "license": "98303",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "REGINA",
            "last_name": "PEACOCK",
            "middle_name": "J",
            "prefix": "MISS",
            "credential": "LCSW",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Patelprofessional Dental Corp.
• Patricia Ann Pompa, D.D.S., Inc.
• Linda C. Patterson
• Harold Glenn Patton, DIRECTOR
• Itzel Payan-Caro, MS, PPS
• Andrew Peckich
• Pedro M Sandoval DDS Corporation
• Gilbert N/a Pena, RDA
• Emily Ann Penland
• Jasmine D Penn

• Clinical Social Worker in Rialto, CA
• Providers in Rialto, CA by specialty
• Clinical Social Worker in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 5, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.