Healthcare Provider Details

I. General information

NPI: 1689712218
Provider Name (Legal Business Name): ANNE M. REGAN PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/04/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11249 LOCKWOOD DR STE C
SILVER SPRING MD
20901-4563
US

IV. Provider business mailing address

11249 LOCKWOOD DR STE C
SILVER SPRING MD
20901-4564
US

V. Phone/Fax

Practice location:
  • Phone: 301-989-9145
  • Fax: 301-593-1033
Mailing address:
  • Phone: 301-989-9145
  • Fax: 301-593-1033

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number2974
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: