Provider Demographics
NPI:1306202676
Name:REGAN, AMANDA (LMHC, CASAC, NCC)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:REGAN
Suffix:
Gender:F
Credentials:LMHC, CASAC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:722 WEILAND RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14626-3957
Mailing Address - Country:US
Mailing Address - Phone:585-420-7280
Mailing Address - Fax:
Practice Address - Street 1:722 WEILAND RD
Practice Address - Street 2:SUITE 200
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14626-3957
Practice Address - Country:US
Practice Address - Phone:585-420-7280
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-01-02
Last Update Date:2016-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY22332101YA0400X
NY6597-1101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)