Individual provider Active NPI

Regina Cassar Demetrakeas, LMSW

  • Clinical Social Worker
  • Tawas City, MI
National Provider Identifier
1346380219
Registry record updated Aug 1, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
6801066658 Issued in MI
Practice address
1199 Harris Ave
Tawas City, MI 48763-9681
Phone
(989) 362-8636
NPI assigned
Feb 8, 2007
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Aug 1, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X 6801066658 MI Primary

Addresses

Primary practice location

1199 Harris Ave
Tawas City, MI 48763-9681

Mailing address

PO Box 310
Tawas City, MI 48764-0310
Phone (989) 362-8636

Other practice location 1

702 W Lake Lansing Rd
East Lansing, MI 48823-8526
Phone (517) 332-5342

Other identifiers 1

IdentifierTypeStateIssuer
6801066658OtherMILMSW

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Ausable Valley CMH Past Accepting new patients
Ausable Valley Community Mental Health Services Board Past Accepting new patients

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1170892800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1690848000000",
    "number": "1346380219",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 310",
            "city": "TAWAS CITY",
            "state": "MI",
            "postal_code": "487640310",
            "telephone_number": "989-362-8636"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1199 HARRIS AVE",
            "city": "TAWAS CITY",
            "state": "MI",
            "postal_code": "487639681",
            "telephone_number": "989-362-8636"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "702 W Lake Lansing Rd",
            "address_purpose": "LOCATION",
            "city": "East Lansing",
            "state": "MI",
            "postal_code": "488238526",
            "country_code": "US",
            "telephone_number": "517-332-5342",
            "fax_number": "517-316-2893",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DEMETRAKEAS",
        "first_name": "REGINA",
        "middle_name": "CASSAR",
        "credential": "LMSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-02-08",
        "last_updated": "2023-08-01",
        "certification_date": "2023-08-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MI",
            "license": "6801066658",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LMSW",
            "identifier": "6801066658",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Tawas City, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 1, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.