Provider Demographics
NPI:1043066327
Name:REGACHO, ANN MARIE (LCSW)
Entity type:Individual
Prefix:
First Name:ANN
Middle Name:MARIE
Last Name:REGACHO
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:38613 HEMLOCK DR
Mailing Address - Street 2:
Mailing Address - City:FRANKFORD
Mailing Address - State:DE
Mailing Address - Zip Code:19945-4623
Mailing Address - Country:US
Mailing Address - Phone:302-604-1225
Mailing Address - Fax:
Practice Address - Street 1:38613 HEMLOCK DR
Practice Address - Street 2:
Practice Address - City:FRANKFORD
Practice Address - State:DE
Practice Address - Zip Code:19945-4623
Practice Address - Country:US
Practice Address - Phone:302-604-1225
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-26
Last Update Date:2024-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEQ1-00124471041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE00570OtherDE BCBS HIGHMARK
DE60054OtherAETNA