MEDICARE: ROBERT F FAGHAN MLADC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor

General Provider Information

NPI Number	:	1629234596
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROBERT F FAGHAN MLADC

Provider Business Mailing Address
First Line	:	2 PUZZLE LN UNIT 2-1
Second Line	:
City	:	NEWTON
State	:	NH
Zip	:	03858-3721
Country	:	US
Telephone Number	:	603-702-2461
Fax Number	:

Provider Business Practice Location Address
First Line	:	2 PUZZLE LN UNIT 2-1
Second Line	:
City	:	NEWTON
State	:	NH
Zip	:	03858-3721
Country	:	US
Telephone Number	:	603-702-2461
Fax Number	:	866-583-7733

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/31/2008
Last Update Date	:	06/21/2020

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