Provider Demographics
NPI:1740860071
Name:REAGAN, ZANDRA J (MS, NCSP)
Entity type:Individual
Prefix:
First Name:ZANDRA
Middle Name:J
Last Name:REAGAN
Suffix:
Gender:F
Credentials:MS, NCSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:89 CHARTIER LN
Mailing Address - Street 2:
Mailing Address - City:ALSTEAD
Mailing Address - State:NH
Mailing Address - Zip Code:03602-3628
Mailing Address - Country:US
Mailing Address - Phone:603-499-1181
Mailing Address - Fax:
Practice Address - Street 1:122 NH ROUTE 12A UNIT 5
Practice Address - Street 2:
Practice Address - City:LANGDON
Practice Address - State:NH
Practice Address - Zip Code:03602-8263
Practice Address - Country:US
Practice Address - Phone:603-835-7102
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-12
Last Update Date:2021-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH69083103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool