Healthcare Provider Details

I. General information

NPI: 1447885868
Provider Name (Legal Business Name): KATHLEEN REGAN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/05/2020
Last Update Date: 03/05/2020
Certification Date: 03/05/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

79 MT VERNON ROAD
NEW BOSTON NH
03070
US

IV. Provider business mailing address

13 BUNKER HILL RD
NEW BOSTON NH
03070-4806
US

V. Phone/Fax

Practice location:
  • Phone: 603-315-1254
  • Fax:
Mailing address:
  • Phone: 603-203-9087
  • 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: JAMIR STONER
Title or Position: PRACTICE MANAGER
Credential:
Phone: 603-203-9087