Provider Demographics
NPI:1144727488
Name:HUMPHREY, REGAN MICHELLE
Entity type:Individual
Prefix:MISS
First Name:REGAN
Middle Name:MICHELLE
Last Name:HUMPHREY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:75 BROWN RD
Mailing Address - Street 2:
Mailing Address - City:HARRISVILLE
Mailing Address - State:NH
Mailing Address - Zip Code:03450-5502
Mailing Address - Country:US
Mailing Address - Phone:678-768-2772
Mailing Address - Fax:
Practice Address - Street 1:489 BERNARDSTON RD
Practice Address - Street 2:
Practice Address - City:GREENFIELD
Practice Address - State:MA
Practice Address - Zip Code:01301-1238
Practice Address - Country:US
Practice Address - Phone:413-774-6252
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-12
Last Update Date:2018-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling