Healthcare Provider Details

I. General information

NPI: 1700244944
Provider Name (Legal Business Name): NICK FAGER LMHC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/03/2016
Last Update Date: 01/09/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

225 BROADWAY STE 3009
NEW YORK NY
10007-3071
US

IV. Provider business mailing address

84 HORATIO ST APT 4C
NEW YORK NY
10014-1561
US

V. Phone/Fax

Practice location:
  • Phone: 203-253-6602
  • Fax:
Mailing address:
  • Phone: 203-253-6602
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: