Healthcare Provider Details

I. General information

NPI: 1386783835
Provider Name (Legal Business Name): ERNEST J GAGNON MSW & NHA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/05/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

57 E FULTON ST
GLOVERSVILLE NY
12078-3212
US

IV. Provider business mailing address

PO BOX 433
CAROGA LAKE NY
12032-0433
US

V. Phone/Fax

Practice location:
  • Phone: 518-773-3531
  • Fax: 518-773-9103
Mailing address:
  • Phone: 518-835-6293
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number028057-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: