Provider Demographics
NPI:1780894030
Name:REGENSBERG, CARL J (LADAC)
Entity type:Individual
Prefix:MR
First Name:CARL
Middle Name:J
Last Name:REGENSBERG
Suffix:
Gender:M
Credentials:LADAC
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:2701 COCONO DR SW
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87105-7089
Mailing Address - Country:US
Mailing Address - Phone:505-873-1935
Mailing Address - Fax:
Practice Address - Street 1:2301 YALE BLVD SE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87106-4228
Practice Address - Country:US
Practice Address - Phone:505-247-4622
Practice Address - Fax:505-247-1373
Is Sole Proprietor?:No
Enumeration Date:2007-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM3676101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)