Provider Demographics
NPI:1790367381
Name:REGAN, THOMAS BABINGTON
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:BABINGTON
Last Name:REGAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:315 W BROADWAY
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02127-1912
Mailing Address - Country:US
Mailing Address - Phone:617-719-8597
Mailing Address - Fax:
Practice Address - Street 1:315 W BROADWAY
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02127-1912
Practice Address - Country:US
Practice Address - Phone:617-719-8597
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-23
Last Update Date:2021-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health