Provider Demographics
NPI:1891991105
Name:REGAN, KATIE M (MSW, LCSW, ACSW)
Entity Type:Individual
Prefix:
First Name:KATIE
Middle Name:M
Last Name:REGAN
Suffix:
Gender:F
Credentials:MSW, LCSW, ACSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:412 N MERIDIAN ST
Mailing Address - Street 2:
Mailing Address - City:GREENTOWN
Mailing Address - State:IN
Mailing Address - Zip Code:46936-1226
Mailing Address - Country:US
Mailing Address - Phone:765-628-3482
Mailing Address - Fax:
Practice Address - Street 1:412 N MERIDIAN ST
Practice Address - Street 2:
Practice Address - City:GREENTOWN
Practice Address - State:IN
Practice Address - Zip Code:46936-1226
Practice Address - Country:US
Practice Address - Phone:765-628-3482
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34004495A1041C0700X
NJ44SC005238001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical