Healthcare Provider Details

I. General information

NPI: 1528889201
Provider Name (Legal Business Name): FREDERICK GAGER PSYCHOLOGY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/24/2024
Last Update Date: 11/12/2024
Certification Date: 11/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

81 COURT ST
KEENE NH
03431-3409
US

IV. Provider business mailing address

180 COURT ST
KEENE NH
03431-3412
US

V. Phone/Fax

Practice location:
  • Phone: 603-903-9330
  • Fax:
Mailing address:
  • Phone: 603-903-9330
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: FREDERICK PAUL GAGER
Title or Position: MEMBER
Credential: PSY.D.
Phone: 603-903-9330