Healthcare Provider Details

I. General information

NPI: 1285919993
Provider Name (Legal Business Name): JAMIE REGAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/13/2011
Last Update Date: 10/13/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 MAPLE ST
SPRINGFIELD MA
01103-2203
US

IV. Provider business mailing address

120 MAPLE ST
SPRINGFIELD MA
01103-2203
US

V. Phone/Fax

Practice location:
  • Phone: 413-737-3730
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VII. Legacy identifiers

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

# 1
Identifier1300881
Identifier TypeMEDICAID
Identifier StateMA
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: