Individual provider Active NPI

Andrea Mary Regenberg, LCSW-C

  • Clinical Social Worker
  • Owings Mills, MD
National Provider Identifier
1750574463
Registry record updated Aug 26, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
10653 Issued in MD
Practice address
825 Queens Park Dr
Owings Mills, MD 21117-2251
Phone
(410) 526-7882
NPI assigned
Aug 26, 2007
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Aug 26, 2007

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 10653 MD Primary

Addresses

Primary practice location

825 Queens Park Dr
Owings Mills, MD 21117-2251

Mailing address

37 Main St
Reisterstown, MD 21136-1236
Phone (410) 526-7882

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)
Not enrolled

State licenses

LicenseStateTypeSpecialty
10653MDMDClinical Social Worker

NPI Registry JSON

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

{
    "created_epoch": "1188086400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1188086400000",
    "number": "1750574463",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "37 MAIN ST",
            "city": "REISTERSTOWN",
            "state": "MD",
            "postal_code": "211361236",
            "telephone_number": "410-526-7882",
            "fax_number": "410-526-9855"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "825 QUEENS PARK DR",
            "city": "OWINGS MILLS",
            "state": "MD",
            "postal_code": "211172251",
            "telephone_number": "410-526-7882"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "REGENBERG",
        "first_name": "ANDREA",
        "middle_name": "MARY",
        "credential": "LCSW-C",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-08-26",
        "last_updated": "2007-08-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MD",
            "license": "10653",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Owings Mills, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 26, 2007; 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.