Provider Demographics
NPI:1306057997
Name:REGAN, MARJORIE LUCY (MA, LMFT)
Entity type:Individual
Prefix:MRS
First Name:MARJORIE
Middle Name:LUCY
Last Name:REGAN
Suffix:
Gender:F
Credentials:MA, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28 VISTA DR
Mailing Address - Street 2:
Mailing Address - City:KINGSTON
Mailing Address - State:NY
Mailing Address - Zip Code:12401-4757
Mailing Address - Country:US
Mailing Address - Phone:845-338-6938
Mailing Address - Fax:
Practice Address - Street 1:28 VISTA DR
Practice Address - Street 2:
Practice Address - City:KINGSTON
Practice Address - State:NY
Practice Address - Zip Code:12401-4757
Practice Address - Country:US
Practice Address - Phone:845-338-6938
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-24
Last Update Date:2012-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000150106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist