Healthcare Provider Details

I. General information

NPI: 1740062835
Provider Name (Legal Business Name): MOLLY FAGAN LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/16/2023
Last Update Date: 10/16/2023
Certification Date: 10/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 COURT ST UNIT 315
MORRISTOWN NJ
07960-5531
US

IV. Provider business mailing address

30 COURT ST UNIT 315
MORRISTOWN NJ
07960-5531
US

V. Phone/Fax

Practice location:
  • Phone: 973-704-4965
  • Fax:
Mailing address:
  • Phone: 973-704-4965
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number44SC05598100
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: