MEDICARE: NICK FAGER LMHC

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	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1700244944
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICK FAGER LMHC

Provider Business Mailing Address
First Line	:	84 HORATIO ST APT 4C
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10014-1561
Country	:	US
Telephone Number	:	203-253-6602
Fax Number	:

Provider Business Practice Location Address
First Line	:	225 BROADWAY STE 3009
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10007-3071
Country	:	US
Telephone Number	:	203-253-6602
Fax Number	:

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

Provider Enumeration Date	:	02/03/2016
Last Update Date	:	01/09/2018

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