Healthcare Provider Details

I. General information

NPI: 1508208380
Provider Name (Legal Business Name): BARBARA FAGGINS PH.D
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/22/2013
Last Update Date: 07/22/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 N CREST PL
LAKEWOOD NJ
08701-2967
US

IV. Provider business mailing address

5 N CREST PL
LAKEWOOD NJ
08701-2967
US

V. Phone/Fax

Practice location:
  • Phone: 215-525-4970
  • Fax: 732-886-2130
Mailing address:
  • Phone: 215-525-4970
  • Fax: 732-886-2130

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberBH000240
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: