Provider Demographics
NPI:1356481022
Name:REAGAN LCSWC, JAMES WILLIAM (LCSWC CLINICAL SOCIA)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:WILLIAM
Last Name:REAGAN LCSWC
Suffix:
Gender:M
Credentials:LCSWC CLINICAL SOCIA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19758 DOGSTREET RD
Mailing Address - Street 2:
Mailing Address - City:KEEDYSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21756
Mailing Address - Country:US
Mailing Address - Phone:301-432-0594
Mailing Address - Fax:
Practice Address - Street 1:19758 DOGSTREET RD
Practice Address - Street 2:
Practice Address - City:KEEDYSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21756
Practice Address - Country:US
Practice Address - Phone:301-432-0594
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD007031041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD34829001OtherBLUE CROSS CARE FIRST