=====================================================
General NPI Number Information
=====================================================
NPI Number | 1023129889
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ALANNA D. REGAN L.C.S.W.-R
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/31/2006
-----------------------------------------------------
Last Update Date | 05/29/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 267 E MAIN ST BLDG. B-23
-----------------------------------------------------
City | SMITHTOWN
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11787-2874
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 516-652-4487
-----------------------------------------------------
Fax | 631-751-5132
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 116 TUTHILL ST
-----------------------------------------------------
City | PORT JEFFERSON
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11777-1824
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 516-652-4487
-----------------------------------------------------
Fax | 631-751-5132
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | R070974-1
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------