Provider Demographics
NPI:1710412226
Name:MEZHERITSKY, REGINA (LCSW)
Entity type:Individual
Prefix:
First Name:REGINA
Middle Name:
Last Name:MEZHERITSKY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:44 COLLEGE PL
Mailing Address - Street 2:
Mailing Address - City:RIDGEFIELD PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07660-2250
Mailing Address - Country:US
Mailing Address - Phone:201-637-9650
Mailing Address - Fax:
Practice Address - Street 1:114 KINDERKAMACK RD
Practice Address - Street 2:
Practice Address - City:PARK RIDGE
Practice Address - State:NJ
Practice Address - Zip Code:07656-2126
Practice Address - Country:US
Practice Address - Phone:201-391-1355
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-23
Last Update Date:2019-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SL06224900104100000X
NJ44SC058343001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker