Provider Demographics
NPI:1538908785
Name:KAMELESKY, REGINA ANN (MSW LISW)
Entity type:Individual
Prefix:
First Name:REGINA
Middle Name:ANN
Last Name:KAMELESKY
Suffix:
Gender:F
Credentials:MSW LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:308 EASTWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:OREGON
Mailing Address - State:OH
Mailing Address - Zip Code:43616-2414
Mailing Address - Country:US
Mailing Address - Phone:419-708-8346
Mailing Address - Fax:
Practice Address - Street 1:1200 S DETROIT AVE
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43614-5903
Practice Address - Country:US
Practice Address - Phone:419-259-2000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-20
Last Update Date:2024-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI.23050221041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical