Provider Demographics
NPI:1275637738
Name:REGAN, BARBARA LYNN (MFT)
Entity type:Individual
Prefix:MS
First Name:BARBARA
Middle Name:LYNN
Last Name:REGAN
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:BARBARA
Other - Middle Name:LYNN
Other - Last Name:REGAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MFT
Mailing Address - Street 1:4100 MOORPARK AVE
Mailing Address - Street 2:SUITE 215
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95117-1703
Mailing Address - Country:US
Mailing Address - Phone:408-280-1804
Mailing Address - Fax:
Practice Address - Street 1:4100 MOORPARK AVE
Practice Address - Street 2:SUITE 215
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95117-1703
Practice Address - Country:US
Practice Address - Phone:408-280-1804
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC22434106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist