| Glenn S. Fagen Phd Inc | |
|
100 King St Suite 303 Northampton MA 01060-3243 | |
| (413) 584-8339 | |
| (413) 584-8339 |
| Full Name | Glenn S. Fagen Phd Inc |
|---|---|
| Speciality | Clinic/Center |
| Location | 100 King St, Northampton, Massachusetts |
| Authorized Official Name and Position | Glenn Scott Fagen (PRESIDENT) |
| Authorized Official Contact | 4135848339 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Glenn S. Fagen Phd Inc 100 King St Suite 303 Northampton MA 01060-3243 Ph: (413) 584-8339 | Glenn S. Fagen Phd Inc 100 King St Suite 303 Northampton MA 01060-3243 Ph: (413) 584-8339 |
| NPI Number | 1518261874 |
|---|---|
| Provider Enumeration Date | 12/30/2010 |
| Last Update Date | 04/26/2011 |
| Medicare PECOS PAC ID | 5294910063 |
|---|---|
| Medicare Enrollment ID | O20110421000621 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1518261874 | NPI | - | NPPES |
| 0524484 | Medicaid | MA | |
| W05440 | Other | MA | BLUE CROSS AND BLUE SHIELD |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | 6793 (Massachusetts) | Primary |
| Provider Name | Glenn S Fagen |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1932134947 PECOS PAC ID: 6709061476 Enrollment ID: I20110421000685 |
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