Healthcare Provider Details

I. General information

NPI: 1992046114
Provider Name (Legal Business Name): EDWARD MICHAEL REGAN M.S., M.S.W., LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/13/2013
Last Update Date: 03/13/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

251 MAIN ST 101
OLD SAYBROOK CT
06475-2357
US

IV. Provider business mailing address

114 BLACK POINT RD
NIANTIC CT
06357-2937
US

V. Phone/Fax

Practice location:
  • Phone: 860-388-9656
  • Fax:
Mailing address:
  • Phone: 860-514-7062
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number007874
License Number StateCT

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: