Provider Demographics
NPI:1447678289
Name:REGAN, DIANE C
Entity type:Individual
Prefix:MRS
First Name:DIANE
Middle Name:C
Last Name:REGAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:DIANE
Other - Middle Name:C
Other - Last Name:DIERCKSEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1 LINCOLN CT
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND MILLS
Mailing Address - State:NY
Mailing Address - Zip Code:10930-2732
Mailing Address - Country:US
Mailing Address - Phone:845-238-9827
Mailing Address - Fax:
Practice Address - Street 1:1 LINCOLN CT
Practice Address - Street 2:
Practice Address - City:HIGHLAND MILLS
Practice Address - State:NY
Practice Address - Zip Code:10930-2732
Practice Address - Country:US
Practice Address - Phone:845-238-9827
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-03-30
Last Update Date:2014-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator