Provider Demographics
NPI:1063141901
Name:REGAN, KYRIE (LSW)
Entity type:Individual
Prefix:MRS
First Name:KYRIE
Middle Name:
Last Name:REGAN
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4257 WOODACRES DR
Mailing Address - Street 2:
Mailing Address - City:EAST STROUDSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:18301-7138
Mailing Address - Country:US
Mailing Address - Phone:570-982-6626
Mailing Address - Fax:
Practice Address - Street 1:149 SAWMILL CT
Practice Address - Street 2:
Practice Address - City:EAST STROUDSBURG
Practice Address - State:PA
Practice Address - Zip Code:18301-8105
Practice Address - Country:US
Practice Address - Phone:570-517-7153
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-07
Last Update Date:2022-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW137929104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker