Provider Demographics
NPI:1568680007
Name:REAGAN, MARY ANN (LMFT)
Entity Type:Individual
Prefix:MS
First Name:MARY ANN
Middle Name:
Last Name:REAGAN
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:256 FAIRLAWN AVE
Mailing Address - Street 2:
Mailing Address - City:WATERBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06705-2122
Mailing Address - Country:US
Mailing Address - Phone:203-596-9145
Mailing Address - Fax:203-596-9145
Practice Address - Street 1:4 SUMMIT RD
Practice Address - Street 2:
Practice Address - City:PROSPECT
Practice Address - State:CT
Practice Address - Zip Code:06712-1485
Practice Address - Country:US
Practice Address - Phone:203-596-9145
Practice Address - Fax:203-596-9145
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000160106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist