Provider Demographics
NPI:1508293739
Name:ROOT, REGAN (MED, BCBA)
Entity Type:Individual
Prefix:
First Name:REGAN
Middle Name:
Last Name:ROOT
Suffix:
Gender:F
Credentials:MED, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 BACTON HILL ROAD
Mailing Address - Street 2:SUITE 105
Mailing Address - City:FRAZER
Mailing Address - State:PA
Mailing Address - Zip Code:19355
Mailing Address - Country:US
Mailing Address - Phone:215-322-8860
Mailing Address - Fax:
Practice Address - Street 1:1 N BACTON HILL RD
Practice Address - Street 2:SUITE 105
Practice Address - City:FRAZER
Practice Address - State:PA
Practice Address - Zip Code:19355-1047
Practice Address - Country:US
Practice Address - Phone:215-322-8860
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-10-02
Last Update Date:2013-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst