Regine Blaise, FPMHNP

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

F404790 Issued in NY

Practice address

11835 Queens Blvd Ste 1630
Forest Hills, NY 11375-7256

Phone

(925) 231-4325

NPI assigned

Feb 27, 2023

Last updated

Apr 24, 2025By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in NY, NJ2 enrollments

Eligible to order & refer

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

Green means eligible to order or refer.

Enrollment records 2

Specialty

Nurse Practitioner

Education

Other, 2022

Medicare assignment

May accept Medicare assignment

Telehealth

Offers telehealth services

Group practices

Carmel Psychological Health PCGroup PAC ID 4385530351, 222 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: lifestancehealth.regineblaise@142175.advancedmd-direct.com

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

• Carmel Psychological Health, PC

  dba LifeStance Psychology

  • Psychologist
  • Carmel, NY
  • NPI 1720194335

  Single Specialty

  Medicare reassignment Care Compare group NPD
• Helping Hands With Regine NP in Psychiatry PLLC

  • Adult Psychiatric/Mental Health Registered Nurse
  • West Babylon, NY
  • NPI 1013770916

  NJ, Single Specialty

  Medicare reassignment NPD Authorized official
• Brookview Medical Associates, PLLC

  • General Practice Physician
  • Bohemia, NY
  • NPI 1871965855

  Single Specialty

  Medicare reassignment NPD
• Aldad Medical PC

  • Psychiatry Physician
  • Ann Arbor, MI
  • NPI 1174784953

  NY, Single Specialty

  Medicare reassignment NPD
• Mental Health Specialty Group PA

  dba Rula Health

  • Mental Health Counselor
  • Durham, NC
  • NPI 1801472634

  NY, Single Specialty

  Medicare reassignment NPD

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

{
    "created_epoch": "1677456000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1745452800000",
    "number": "1144929209",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1133",
            "city": "WEST BABYLON",
            "state": "NY",
            "postal_code": "117040133",
            "telephone_number": "631-987-4632"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11835 QUEENS BLVD STE 1630",
            "city": "FOREST HILLS",
            "state": "NY",
            "postal_code": "113757256",
            "telephone_number": "925-231-4325"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "276 5th Ave # 704-2112",
            "address_purpose": "LOCATION",
            "city": "New York",
            "state": "NY",
            "postal_code": "100014509",
            "country_code": "US",
            "telephone_number": "415-671-2165",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BLAISE",
        "first_name": "REGINE",
        "name_prefix": "Miss",
        "credential": "FPMHNP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2023-02-27",
        "last_updated": "2025-04-24",
        "certification_date": "2025-04-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "NJ",
            "license": "26NJ15040200",
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "NY",
            "license": "F404790",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Bjsrx Inc (BJS Drugs)
• Annie Black, M. A., P. T.
• Leslyn Vianca Black
• Georgette Blain
• Merissa Blais, DDS
• Ranique R Blake
• Jessica Blamoville
• Heather Blaney
• Betty Blau
• Hallie J Bleau

• Psychiatric/Mental Health Nurse Practitioner in Forest Hills, NY
• Providers in Forest Hills, NY by specialty
• Psychiatric/Mental Health Nurse Practitioner in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 24, 2025; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.