Provider Demographics
NPI:1831442128
Name:BEDREGAL, LUIS E (PHD)
Entity type:Individual
Prefix:DR
First Name:LUIS
Middle Name:E
Last Name:BEDREGAL
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:175 MILL POND RD
Mailing Address - Street 2:UNIT 345
Mailing Address - City:HAMDEN
Mailing Address - State:CT
Mailing Address - Zip Code:06514-1729
Mailing Address - Country:US
Mailing Address - Phone:203-848-8997
Mailing Address - Fax:
Practice Address - Street 1:175 MILL POND RD
Practice Address - Street 2:UNIT 345
Practice Address - City:HAMDEN
Practice Address - State:CT
Practice Address - Zip Code:06514-1729
Practice Address - Country:US
Practice Address - Phone:203-848-8997
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-24
Last Update Date:2012-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT003220103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical