Provider Demographics
NPI:1366203598
Name:MANTOR, REGAN ALEXANDRA (LMSW-CC)
Entity type:Individual
Prefix:
First Name:REGAN
Middle Name:ALEXANDRA
Last Name:MANTOR
Suffix:
Gender:F
Credentials:LMSW-CC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:433 THURSTON HILL RD
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:ME
Mailing Address - Zip Code:04950-3809
Mailing Address - Country:US
Mailing Address - Phone:207-431-0755
Mailing Address - Fax:
Practice Address - Street 1:16 PRESCOTT DRIVE
Practice Address - Street 2:
Practice Address - City:HINKLEY
Practice Address - State:ME
Practice Address - Zip Code:04944
Practice Address - Country:US
Practice Address - Phone:207-238-4000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-16
Last Update Date:2024-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEMC231781041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical