Provider Demographics
NPI:1023129889
Name:REGAN, ALANNA D (LCSW-R)
Entity type:Individual
Prefix:
First Name:ALANNA
Middle Name:D
Last Name:REGAN
Suffix:
Gender:F
Credentials:LCSW-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:116 TUTHILL ST
Mailing Address - Street 2:
Mailing Address - City:PORT JEFFERSON
Mailing Address - State:NY
Mailing Address - Zip Code:11777-1824
Mailing Address - Country:US
Mailing Address - Phone:516-652-4487
Mailing Address - Fax:631-751-5132
Practice Address - Street 1:267 E MAIN ST
Practice Address - Street 2:BLDG. B-23
Practice Address - City:SMITHTOWN
Practice Address - State:NY
Practice Address - Zip Code:11787-2874
Practice Address - Country:US
Practice Address - Phone:516-652-4487
Practice Address - Fax:631-751-5132
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2013-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR070974-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYP2781903OtherOXFORD PROVIDER ID #
NYN536E1Medicare PIN