Healthcare Provider Details

I. General information

NPI: 1447078340
Provider Name (Legal Business Name): DELIA REGAN MA, MMTC, NCC, MT-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/30/2024
Last Update Date: 09/30/2024
Certification Date: 09/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

161 JACKSON ST
LOWELL MA
01852-2103
US

IV. Provider business mailing address

5 FREEPORT AVE
METHUEN MA
01844-1945
US

V. Phone/Fax

Practice location:
  • Phone: 978-937-9700
  • Fax:
Mailing address:
  • Phone: 978-973-8523
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: