Provider Demographics
NPI:1134828502
Name:REGAN, MACIE MARIE (LMFT)
Entity type:Individual
Prefix:
First Name:MACIE
Middle Name:MARIE
Last Name:REGAN
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 1:187 LOVERS LN UNIT 61
Mailing Address - Street 2:
Mailing Address - City:TORRINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06790-4364
Mailing Address - Country:US
Mailing Address - Phone:860-201-7066
Mailing Address - Fax:
Practice Address - Street 1:187 LOVERS LN UNIT 61
Practice Address - Street 2:
Practice Address - City:TORRINGTON
Practice Address - State:CT
Practice Address - Zip Code:06790-4364
Practice Address - Country:US
Practice Address - Phone:860-201-7066
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-24
Last Update Date:2023-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT3007106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist