1023129889 NPI number — ALANNA D. REGAN L.C.S.W.-R

Table of content: ALANNA D. REGAN L.C.S.W.-R (NPI 1023129889)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1023129889 NPI number — ALANNA D. REGAN L.C.S.W.-R

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
REGAN
Provider First Name:
ALANNA
Provider Middle Name:
D.
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
L.C.S.W.-R
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1023129889
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/29/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
116 TUTHILL ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PORT JEFFERSON
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11777-1824
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
516-652-4487
Provider Business Mailing Address Fax Number:
631-751-5132

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
267 E MAIN ST
Provider Second Line Business Practice Location Address:
BLDG. B-23
Provider Business Practice Location Address City Name:
SMITHTOWN
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11787-2874
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
516-652-4487
Provider Business Practice Location Address Fax Number:
631-751-5132
Provider Enumeration Date:
08/31/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  R070974-1 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: P2781903 . This is a "OXFORD PROVIDER ID #" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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