Individual
STACEY REGNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MT-BC
Contact information
Practice address
1617 WILLOWHURST AVE, SAN JOSE, CA 95125-5561
(408) 531-6428
Mailing address
1617 WILLOWHURST AVE, SAN JOSE, CA 95125-5561
(408) 531-6428
Taxonomy
Speciality
Code
Description
License number
State
225A00000X
Music Therapist
Primary
09965
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
09965
CERTIFICATION BOARD FOR MUSIC THERAPISTS (CBMT)
—
Enumeration date
09/07/2016
Last updated
09/07/2016
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