Provider Demographics
NPI:1912383621
Name:REGAN, MICHAEL (LCSW)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:REGAN
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 SULLIVAN AVE
Mailing Address - Street 2:
Mailing Address - City:PORT JERVIS
Mailing Address - State:NY
Mailing Address - Zip Code:12771-1616
Mailing Address - Country:US
Mailing Address - Phone:570-906-0168
Mailing Address - Fax:
Practice Address - Street 1:33 BUCK HILL RD
Practice Address - Street 2:
Practice Address - City:WURTSBORO
Practice Address - State:NY
Practice Address - Zip Code:12790-5227
Practice Address - Country:US
Practice Address - Phone:570-906-0168
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-04
Last Update Date:2024-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0891961041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical