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NPI Code Detail

MEDICARE: MS. MARIANNE REGAN MFT

MEDICARE:  MS. MARIANNE  REGAN  MFT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1106H00000XMarriage & Family TherapistMFC35495CA

General Provider Information

NPI Number : 1720293459
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. MARIANNE REGAN MFT
Provider Business Mailing Address
First Line : 73 PREDA ST
Second Line :
City : SAN LEANDRO
State : CA
Zip : 94577-1439
Country : US
Telephone Number : 510-543-7870
Fax Number :
Provider Business Practice Location Address
First Line : 2728 RUSSELL ST
Second Line :
City : BERKELEY
State : CA
Zip : 94705-2318
Country : US
Telephone Number : 510-652-6600
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/14/2007
Last Update Date : 07/08/2007

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Directions to “ MS. MARIANNE REGAN MFT” Practice Location

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